Technique for Implantation of Fiducial Markers in the Prostate

Shinohara, Katsuto; Roach, Mack

doi:10.1016/j.urology.2007.10.011

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Volume 71, Issue 2 , Pages 196-200, February 2008

Technique for Implantation of Fiducial Markers in the Prostate

Katsuto Shinohara
- Department of Urology, University of California San Francisco and UCSF/Mt. Zion Comprehensive Cancer Center, San Francisco, California
- Department of Radiation Oncology, University of California San Francisco and UCSF/Mt. Zion Comprehensive Cancer Center, San Francisco, California
- Drs. Shinohara and Roach have been investigators in clinical trials sponsored by Calypso Medical Technologies, Inc.
- Dr. Shinohara has been a paid consultant of Calypso Medical Technologies, Inc.
- Reprint requests: Katsuto Shinohara, M.D., University of California San Francisco and UCSF/Mt. Zion Comprehensive Cancer, Box 0711, San Francisco, CA 94143-0711.
Mack Roach III
- Department of Urology, University of California San Francisco and UCSF/Mt. Zion Comprehensive Cancer Center, San Francisco, California
- Department of Radiation Oncology, University of California San Francisco and UCSF/Mt. Zion Comprehensive Cancer Center, San Francisco, California
- Drs. Shinohara and Roach have been investigators in clinical trials sponsored by Calypso Medical Technologies, Inc.

Received 6 April 2007; accepted 18 October 2007.

Objectives

To describe our experience in developing a technique for implanting fiducial markers (gold markers and electromagnetic transponders) in the prostate by the transrectal approach under ultrasound guidance.

Methods

Our technique requires an endocavitary probe (ultrasound transducer) designed for prostate imaging, an ultrasound system with software to visualize the biopsy trajectory on the imaging screen, and a needle guide specifically designed to fit the probe. Critical aspects of the technique include identifying appropriate implantation locations in the gland, correctly orienting the bevel of the implantation needles, ensuring that the bevel is completely within the gland before deploying markers, and achieving adequate spacing of the markers.

Results

Since 1999 we have successfully implanted gold markers in 705 patients. Only 1 patient has developed a urinary tract infection requiring additional antibiotic therapy. There have been no instances of severe rectal bleeding or gross hematuria requiring further intervention. Complication rates have been similarly low for electromagnetic transponders implanted in 44 patients.

Conclusions

Implantation of fiducial markers is being used to achieve greater accuracy of external beam radiation therapy for prostate cancer. Our experience can serve as a guide to clinicians for performing this increasingly important procedure in an effective and problem-free manner.