Insertion of Intraprostate Gold Fiducial Markers in Prostate Cancer Treatment

Background and Aims: Surgery and radiotherapy continue to be the treatments of choice for localised and locally advanced prostate cancer. In recent years, we have witnessed significant development in radiotherapy techniques in order to increase the dose on the target volume and diminish side effects. In the following work, we describe the technique of insertion of gold fiducial markers (gold seeds) as well as their application and usefulness in the treatment of localized and locally advanced prostate adenocarcinoma with image guided radiotherapy (IGRT) by means of the Exac Trac® system. Methods: We did a prospective descriptive study including consecutive patients undergoing IGRT in our hospital. Patients were reviewed one week after the insertion of the markers and in each radiotherapic session. Between October 2005 and June 2007, we carried out a total of 126 procedures using this technique. Each patient was interviewed in each radiotherapic session. Three or four gold intraprostatic fiducial markers were implanted in each patient by transrectally and ultrasound guided. We reported patients tolerance of this technique by a satisfaction questionnaire, as well as the early and late complications derived from the insertion of the markers in the clinical interview. We collected the movements of the gold seeds. Results: Complications observed were: urinary infection in 4 cases (3.2%), prostatitis in 2 cases (1.6%), slight pelvic pain in 6 patients (4.8%) and self-limited rectal bleeding in 8 patients (6.4%). None of the patients presented hematuria. Loss of 1 marker was registered in 7 patients (5.5%) and loss of 2 markers in 2 patients (1.6%). Conclusions: Insertion of fiducial markers for prostate cancer treatment is a technique of very simple execution, easy to reproduce almost free of adverse effects, which is able to reduce toxicity derived from radiotherapy and allows dose escalation in radiotherapy.