Single-center experience in prostate fiducial marker placement: technique and midterm follow-up.
OBJECTIVE
To describe the technique, technical success, and complications of prostate fiducial marker implantation using transrectal ultrasound (US) guidance in patients undergoing image-guided radiation therapy.


METHODS
A retrospective review was performed of patients who underwent fiducial marker placement from January 2010-April 2013. In each case, gold markers were placed in the prostate using transrectal US guidance. Computed tomography (CT) was performed after the procedure and evaluated to confirm correct placement. Technical success, complications, and development of symptoms during radiotherapy were reviewed.


RESULTS
Transrectal US-guided fiducial marker placement was performed on 75 patients (mean age, 62 y; range, 48-79 y) with a mean Gleason score of 7.25 (range, 6-10). Fiducial marker placement was confirmed in the intended location of the prostate or prostate bed for 297 of 300 markers (99%) on follow-up CT imaging. Two markers were placed just outside the prostate capsule, and one marker was lost. Complications included sepsis (n = 1; 1.3%), self-limiting perirectal or intraprostatic hemorrhage (n = 3; 4%), nausea (n = 1; 1.3%), transient hypotension (n = 1; 1.3%), epididymitis (n = 1; 1.3%), and urinary tract infection (n = 1; 1.3%). Complications were seen more frequently in patients with high tumor grade (P = .001) and in patients who developed metastatic disease (P = .01).


CONCLUSIONS
Transrectal US-guided implantation of fiducial markers is technically feasible, is well tolerated, and has a good safety profile.
Department of Vascular and Interventional Radiology, University of Miami/Miller School of Medicine, Miami, Florida.
Issam
I
Kably
Department of Radiology, University of Miami/Miller School of Medicine, Miami, Florida. Electronic address: Mbordegaray@med.miami.edu.
Matthew
M
Bordegaray
Department of Jackson Memorial Hospital, University of Miami/Miller School of Medicine, Miami, Florida.
Kush
K
Shah
Department of Vascular and Interventional Radiology, University of Miami/Miller School of Medicine, Miami, Florida.
Jason
J
Salsamendi
Department of Vascular and Interventional Radiology, University of Miami/Miller School of Medicine, Miami, Florida.
Govindarajan
G
Narayanan
D000368:Aged; D004867:Equipment Design; D057918:Fiducial Markers; D005431:Florida; D006046:Gold; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
D006046:Gold