Name of the Procedure:

Placement of interstitial device(s) for radiation therapy guidance, prostate (via needle, any approach), single or multiple. Common names: Fiducial marker placement for prostate radiation therapy.

Summary

This procedure involves placing small devices called fiducial markers inside the prostate gland to help precisely target radiation therapy for prostate cancer. It is done using a needle and can be performed through various approaches.

Purpose

The purpose of placing fiducial markers is to ensure accurate delivery of radiation therapy to the prostate. These markers allow for precise mapping and targeting, minimizing radiation exposure to surrounding healthy tissues.

Indications

• Prostate cancer requiring radiation therapy
• Patients scheduled for external beam radiation therapy or brachytherapy
• Criteria include having a confirmed diagnosis of prostate cancer and undergoing a treatment plan involving radiation.

Preparation

• Patients may be instructed to avoid eating and drinking for several hours before the procedure.
• Medication adjustments, such as blood thinners, might be necessary.
• Imaging tests like MRI or CT scans may be performed prior to the procedure for planning.

Procedure Description

1. The patient is positioned similarly to a prostate biopsy, usually lying on their side or back.
2. Local anesthesia is administered to numb the area.
3. Using ultrasound or imaging guidance, a needle is inserted through the perineum or rectum into the prostate.
4. Fiducial markers (small gold seeds or similar devices) are placed within the prostate via the needle.
5. Multiple markers are often inserted to ensure precise tracking during radiation therapy.
6. The procedure is typically quick, and the patient remains awake, though they may feel some pressure or mild discomfort.

Duration

The procedure typically takes about 20-30 minutes.

Setting

The procedure is generally performed in an outpatient clinic or a hospital's radiology or urology unit.

Personnel

• Urologist or Radiation Oncologist
• Radiologic Technologist
• Nurse
• Anesthesiologist (if sedation beyond local anesthesia is required)

Risks and Complications

• Infection
• Bleeding or bruising at the insertion site
• Discomfort during or after the procedure
• Rarely, marker migration or misplacement

Benefits

• Enhanced accuracy of radiation therapy targeting
• Reduced risk of damage to surrounding healthy tissues
• Potentially better treatment outcomes

Recovery

• Minor bleeding or discomfort may occur and typically resolves within a few days.
• Activities can often be resumed the following day, except strenuous exercise.
• Follow-up appointments are necessary to plan and commence radiation therapy.

Alternatives

• Radiotherapy without fiducial markers, which may be less precise.
• Other prostate cancer treatments, such as surgery or hormone therapy.
• Each option has its benefits and risks that should be discussed with the medical team.

Patient Experience

• During the procedure, the patient might feel mild discomfort or pressure from the needle insertion.
• Post-procedure, minimal pain typically managed with over-the-counter pain relievers.
• Most patients can go home shortly after the procedure and resume normal activities quickly.

Pain management and comfort measures include local anesthesia during the procedure and instructions for managing any mild discomfort afterward.