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Prostate Cancer
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Posted 1/17/2019 7:48 PM (GMT 0)
My brother currently age 56 has been diagnosed with localized reoccurring prostate cancer. Basically his PSA has returned. It has been a slow insidious process but its back! He is a number of years out from surgery… 8+.
He has been advised to start 7 weeks of radiation after 2 months of ADT followed by an additional 4 months of ADT. My question is that the radiation guy wants to place fiducial markers. I thought these markers were old school and no longer used. What is the current thinking about these markers?
Hero
Posted 1/17/2019 8:09 PM (GMT 0)
My RO dose not use them....
Posted 1/17/2019 8:46 PM (GMT 0)
If he had surgery and doesn’t have a prostate, where’s the RO gonna place the fiducials?
Posted 1/17/2019 9:26 PM (GMT 0)
Good questions so far.
Whether fiducials are necessary, or helpful, depends on the radiation equipment and the wisdom of the rad oncologist.
Posted 1/17/2019 9:52 PM (GMT 0)
Had adjuvant radiation starting last July, the RO and techs used sharpie marker for the initial mapping, no permanent tattoos or such.
Posted 1/17/2019 9:56 PM (GMT 0)
for SRT they aren't used. For primary RT, they're not used as much anymore.
Posted 1/17/2019 10:20 PM (GMT 0)
I had tattoos for SRT. I look at them frequently to remind where I have been on the journey.
Posted 1/17/2019 10:58 PM (GMT 0)
Me too Captain. Three dots. I always use think only a fool would get a tattoo. Maybe I was right. Lol
Posted 1/17/2019 11:04 PM (GMT 0)
What Gleason level did he have. Many urologist including my oncology urologist doesn't recommend ADT if GS 7 (3+4) or below. I had GS7 (3+4) and my PSA became detectable 2 years after robotic surgery. So I had 39 session of IGRT/IMRT. It was a piece of cake, no side effects during or after. It has been over 3 years now and everything is fine.
Posted 1/17/2019 11:08 PM (GMT 0)
After eight years he will have SRT. I suspect either your brother, or someone at the office, is using the term "fiducial markers" incorrectly. If not, he may want to talk to another radiation oncologist.
Posted 1/18/2019 12:32 AM (GMT 0)
I believe that gold fiducial markers are used for HDR-BT, SBRT, and possibly for PBRT (protons).

But, that is what I have read from men having primary treatment. Not sure how fiducials would work without a prostate being present.
Posted 1/18/2019 12:40 AM (GMT 0)
Fiducils are only used for External beam radiation therapy (IGRT/SBRT). They, usually three, are placed in the prostate to guide the IGRT process.

I have never heard of them being used for SRT since there is no prostate. Either this is a miss communication or a questionable radiation oncologist. Is the RO a specialist in delivering radiation therapy for prostate cancer? How many SRT procedures has the clinic delivered? Better be in the high hundreds or you should find someone else. What scans have been done? After eight years the probability of cancer being limited to the prostate bed diminishes. If it is outside the radiation field the SRT will be ineffective.
Posted 1/18/2019 12:54 AM (GMT 0)
unless the RO is talking about the calypso fiducial marker - which is a transponder technology sometimes used for abdominal RT.
Posted 1/18/2019 2:36 AM (GMT 0)
Thanks for taking time to reply. This confirms my concern.
Hero
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