title: Transperineal implantation of gold fiducial markers (gold seeds) for prostate image-guided radiation therapy: a feasible technique associated with a low risk of complications.
abstract: The purpose is to describe the method, safety and efficacy of transperineal gold seed placement for image-guided radiation therapy.
  
  
  
  An ethics committee approved database was used to review records of consecutive patients from October 2008 through December 2013, who underwent transperineal implantation of three gold markers into the prostate using staged local anaesthesia and transrectal ultrasound. Seeds were counted on radiographs from CT simulation, first treatment and last treatment. Retention and use of at least three markers for kV/kV matching was considered a successful implant. A visual analogue scale (VAS) pain assessment was performed. SAS was used for data analysis.
  
  
  
  Fiducial marker placement was successful for kV/kV matching in 556/581 patients (95.7%). The procedure was aborted due to pain in two patients. Additional sedation during the procedure was required in two patients. Complications include urinary infections (2 patients, <0.5%) and transient haematuria (2 patients, <0.5%). There were no recorded calls requesting additional pain medication or delays in radiation due to complications. The number of seeds identified at simulation: 4 (2 patients), 3 (554 patients), 2 (21 patients), 1 (1 patient), 0 (1 patient). One patient with three seeds and two patients with <2 seeds had cone beam CT instead of kV/kV imaging for image guidance. No seeds were lost after simulation. The mean visual analogue pain score associated with transperineal gold seed insertion met patients' expectations (respectively 4.1 vs. 4.4 P = 0.19).
  
  
  
  Outpatient transperineal insertion of fiducials avoids the rectum, is effective, convenient, well tolerated and has few side effects.
authors: Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel.
authors: Akram
authors: A
authors: Saad
authors: Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel.
authors: Jeffrey
authors: J
authors: Goldstein
authors: Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat GanIsrael; Sackler School Of Medicine Tel Aviv University Tel Aviv Israel.
authors: Yaacov Richard
authors: YR
authors: Lawrence
authors: Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel.
authors: Ilana
authors: I
authors: Weiss
authors: Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel.
authors: Rasha
authors: R
authors: Saad
authors: Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel.
authors: Benjamin
authors: B
authors: Spieler
authors: Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat GanIsrael; Sackler School Of Medicine Tel Aviv University Tel Aviv Israel.
authors: Zvi
authors: Z
authors: Symon
mesh_terms: D057918:Fiducial Markers / Q000009:adverse effects*; D006046:Gold / Q000528:radiation effects; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000209:etiology; D010502:Perineum / Q000601:surgery; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods* / Q000592:standards
chemical_list: D006046:Gold
keywords: Gold fiducial markers; image‐guided radiation; prostate cancer; transperineal implant