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Thread: Prostate Fiducial Placement - Just how bad is it???

  1. #1
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    Jul 2019
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    Prostate Fiducial Placement - Just how bad is it???

    I just completed a prostate MRI prior to embarking on EBRT. My RO just called and told me that the MRI correlates with the biopsy samples and their are no surprises. The insertion of the colorectal coil was quite painful. (much more so then the biopsy ultrasound.) However after that ordeal, the rest of the MRI was a piece of cake.

    The next step in this journey is a gold seed fiducial placement. Just how bad is this procedure?
    '15-'18: Gradual PSA velocity ramp from .9 to 2.1
    12/18: DRE normal but PCP referred me to URO
    1/19: URO said recheck PSA in 6 mo, DRE normal
    7/19: PSA up to 2.7
    7/19: URO scheduled BX at age 68
    BX Report: 9/12 cores benign, 28cm Prostate
    1 core, left medial mid, 3+4, 3mm, 25% tumor, 10% Grade 4
    1 core, right medial apex, 3+4, 1mm, 14% tumor, 45% Grade 4
    1 core, left lateral apex, 3+4, 7mm, 70% tumor, 10% Grade 4
    Diagnosis: Intermediate PCa (T1, Gleason 7/WHO grade 2, low PSA)
    9/19: Decided on EBRT after consulting with 3 RO's (chosen facility is OHSU Knight Cancer Center)
    10/19: RO orders second opinion on biopsy slides and same conclusions are reached
    10/19: RO orders prostate MRI and results correlate with biopsy
    10/19: Next steps will be Fiducial Seed Placement but no SpaceOar. RO claims SpaceOar is not needed and poses a risk of complications. Estimate start of a 5-1/2 wk EBRT in Dec.

  2. #2
    Since there have been no responses from actual patients, I will offer what I have read elsewhere.

    Men have posted that the placement of fiducials were the worst session of their RT. Everything beyond that was just full bladder control. Not that that was easy.

    Anecdotally, the men seemed very pleased with the RT sessions, and the relative lack of side effects.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  3. #3
    I too have never had any PCa treatment. But a friend is going through 45 days of IMRT + Lupron for his Gleason 8. He's a bit over 3 weeks in and reports no SEs whatsoever. And he didn't say anything bad about the fiducial placement either.

    Best of luck to you.
    Born 1953. All care at Kaiser in LA.

    10/11/18: 2 positive low volume (5-20%) G6 cores out of 12. Prostate vol 33g.
    Jan-June 2019: saw several uros, only initial one recommends treatment: all others AS.
    7/15/19: Dr. Leonard Marks at UCLA: AS. UCLA radiologist finds nothing abnormal in MRI.
    Currently on AS.
    Urolift for BPH 10/21/19

    PSA
    8/2/18: 1.2
    3/26/19: 1.8
    6/14/19: 2.2
    10/18/19: 2.0

    Head and neck cancer 2009: Surgery and 31 days IMRT. NED for 10 years and counting.

  4. #4
    This is what I found for UCLA:

    IMPLANTATION OF PROSTATE FIDUCIAL SEEDS
    You will be called in by the nurse. Your vitals and weight will be taken and you will be put in an exam room to speak with the physician performing your procedure. Once all of your questions have been answered, you will be asked to sign a consent form. If you wish to take a medication to help you relax, it will be given to you at this time. The medication is in the form of a pill, so it will take about 45 minutes to take effect. During this time you will be allowed to remain in the room with the person accompanying you. You may find you wish to have a book or something with you.

    You will also be given a dose of an antibiotic prior to the procedure. This dose is onetime only, you will not be required to get a prescription to continue taking it after the procedure.
    When it is time for your procedure to begin, you will be taken to a different room within the clinic.

    You will be placed on an exam chair with your legs up in stirrups. The radiation oncologist will use local anesthetic (lidocaine) to numb the area around the prostate. This anesthetic is similar to the numbing medicine you get at the dentist's office. An ultrasound probe will be placed into your rectum. Three marker seeds will then be placed within the prostate through ultrasound based needle guidance. The seeds are NOT placed through the rectum, but through the skin on the outside of your body between the scrotum and the rectum.

    On average, this procedure takes 20-30 minutes. You will typically have a CT scan of your prostate after the prostate fiducial seeds have been inserted, unless another plan of care has been created for you by your doctor. This CT scan takes place in the same department as the fiducial seed procedure. Remember to have a comfortably full bladder for the CT scan. Once the CT scan is complete, the calculations and targeting for your radiation treatments can begin.
    Here Memorial Sloan Kettering:
    You will then be brought to the operating room. You will get anesthesia (medication to make you sleep) through your IV.

    Your doctor will use rectal ultrasound to see your prostate. They will insert tiny needles into your prostate through your perineum, which is the area of skin between your scrotum and anus.

    Your doctor will place 3 fiducial markers into your prostate through the needles and then will remove the needles.
    Last edited by OldTiredSailor; 10-18-2019 at 07:07 PM.
    DOB: July 1947
    PSA: 2.0/2004 4.0/2010 5.8/2010 4.5/2012 5.6/2013 Normal DRE
    5/18 PSA: 9.2
    6/18 PSA: 10.2 & 8.4% Free
    6/28 3T mpMRI PIRADS 3
    18 cc gland=PSD 0.57 ng/cc
    0.32 cc lesion in apical PZ with subtle T2 signal hypointensity
    mild restricted diffusion of contrast into lesion prostate unremarkable intact capsule
    7/18 4KScore 34% Probability Gleason =>7

    8/03/18 Bx: Adenocarcinoma 6 of 13 cores ONLY L lobe
    T1c / Grade II / unfavorable intermediate
    extent of G3-G4 tissue far greater than indicated by MRI
    G6 (3+3) 70% LL Base 50% L Lateral Mid 20% L Base
    G7 (3 +4) 100% LL Apex 20% L Mid 60% L Apex
    8/15/18 Clear CT scan and Bone Scan
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported

    PSA
    10/3/18 0.021
    01/4/19 0.018
    04/03/19 0.022
    06/26/19 0.028
    10/1/19 0.035

    Decipher RP = 0.47 Average Risk

  5. #5
    Two years ago I had SBRT as a mono therapy for PCa. As part of that treatment I had three gold seeds placed as fiduciary markers. The procedure was very much the same as my biopsy and was no big deal. I would say it was easier and a little faster than the biopsy since there was not the annoying clicks of the biopsy gun and fewer sticks. The side effects of stained semen where the same. Overall I found the SBRT treatment a great choice for me.

  6. #6
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    Join Date
    Jul 2019
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    13
    ^^Thanks guys.

    It turns out that Fiducial Placement is a piece of cake. The Dr. didn't spend much more then about 5 minutes from start to finish. After the ultrasound probe was inserted, the seed placement was quick and painless. It's a much faster procedure then the prostate biopsy and as a result just not a big deal.

    Prep was the usual Fleet and a couple antibiotic bills prior to the procedure and then an antibiotic shot right after the procedure.

    My seed placement did not include SpaceOar. RO say's it can lead to complications and he claims it's not needed.

    Next step is simulation in 2 wks.
    '15-'18: Gradual PSA velocity ramp from .9 to 2.1
    12/18: DRE normal but PCP referred me to URO
    1/19: URO said recheck PSA in 6 mo, DRE normal
    7/19: PSA up to 2.7
    7/19: URO scheduled BX at age 68
    BX Report: 9/12 cores benign, 28cm Prostate
    1 core, left medial mid, 3+4, 3mm, 25% tumor, 10% Grade 4
    1 core, right medial apex, 3+4, 1mm, 14% tumor, 45% Grade 4
    1 core, left lateral apex, 3+4, 7mm, 70% tumor, 10% Grade 4
    Diagnosis: Intermediate PCa (T1, Gleason 7/WHO grade 2, low PSA)
    9/19: Decided on EBRT after consulting with 3 RO's (chosen facility is OHSU Knight Cancer Center)
    10/19: RO orders second opinion on biopsy slides and same conclusions are reached
    10/19: RO orders prostate MRI and results correlate with biopsy
    10/19: Next steps will be Fiducial Seed Placement but no SpaceOar. RO claims SpaceOar is not needed and poses a risk of complications. Estimate start of a 5-1/2 wk EBRT in Dec.

 

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