Abstract
Purpose Fiducial markers may be used to localize the prostate during radiotherapy using portal film and/or cone-beam CT. The purpose of this study is to describe the technique, efficacy, and complications of transrectal ultrasound (TRUS)-guided prostate fiducial marker placement by interventional radiology. Materials and Methods With IRB approval, medical records of patients who underwent TRUS-guided prostate fiducial marker placement between 1/2011 and 8/2012 were reviewed. Three gold markers, Visicoil (IBA, Bartlett, TN) or AnchorMarker (Biocompatibles, Oxford, CT), were placed, 1 each in the right and left prostate base as well as right apex (1). Post-procedure frontal and lateral radiographs confirmed placement. An additional marker was placed if malposition was noted. Complications of fiducial placement and need for additional localization modality at radiotherapy were recorded. Results In total 111 men with mean age 69 years (range 52—90), mean PSA 11 (range 1—106), mean Gleason score 7 (range 6—9), and clinical stage T1c—T3b underwent marker placement. Prior TURP was noted in in 6 (5.4%), and cryotherapy in 1 (0.9%). Mean prostate volume was 31.5 mL (range 2—130). In 60 (54%), 1% lidocaine was injected into the neurovascular bundle; 51 (46%) received no lidocaine. Moderate sedation due to anxiety was used in 1 (0.9%) and general anesthesia due to anal canal stenosis was used in 1 (0.9%). Malposition of 1 marker was recognized at US in 4 (3.6%) and on radiograph in 2 (1.8%), necessitating additional fiducial placement. In all cases, the fiducials were still used during radiotherapy. Poor visualization of the fiducial markers required additional prostate localization in 3 patients (2.7%) using B-mode acquisition and targeting US. Post-procedure urinary tract infection requiring oral antibiotics occurred in 1 (0.9%). Urosepsis requiring admission and IV antibiotics occurred in 1 (0.9%). Conclusion TRUS-guided prostate fiducial marker placement is a safe and reliable technique that may be performed by the interventional radiologist for subsequent prostate localization during radiotherapy. Reference 1. Shinohara K, Roach M, 3rd. Technique for implantation of fiducial markers in the prostate. Urology. 2008 Feb;71:196–200.
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