It is becoming commonplace for men who are going to get external beam radiotherapy to treat their prostate cancer to have some form of “fiducial marker” (often tiny gold rods or balls) inserted into their prostates under transrectal ultrasound guidance to help ensure that the radiotherapy can be administered with the greatest possible accuracy.
Now it needs to be appreciated that, just like a prostate biopsy, the insertion of fiducial markers is a surgical procedure, and like all surgical procedures, it does come with a (relatively low) level of risk.
Gill et al. have reported data from a retrospective survey of 234 patients who had fiducial markers inserted prior to their radiotherapy. The patients were all given a questionnaire that asked them about the severity and the duration of any symptoms suggesting side effects and complications associated with this procedure.
Here is what they found:
- 75/234 men (32 percent) had at least one new symptom after the procedure.
- 21/234 men (9 percent) had symptoms that lasted for > 2 weeks.
- The most common new symptom that was reported after the procedure was urinary frequency (in 16 percent of patients who had not previously had this problem).
- Haematuria (blood in the urine), rectal bleeding, dysuria (pain on urination) and haematospermia (blood in the sperm) affected 9 to 13 percent of patients, mostly at a low level (grade 1 or 2).
- Between 3 and 4 percent of men reported pain, urinary tract obstruction, and fever and shivers.
- Grade 3 rectal bleeding, haematuria, fever and shivers and urinary frequency affected between 1 and 4 patients (0.5 to 1.5 percent).
- 1/234 patients had a grade 4 complication (i.e., fever and shivers) which was documented as sepsis.
- Urinary frequency, dysuria, obstructive symptoms, and rectal bleeding were the symptoms that most commonly lasted for > 2 weeks.
- The average (mean) pain score during the procedure was 1.1 (range, 0 to 5).
Prostate cancer patients who undergo transrectal ultrasound-guided insertion of fiducial markers to facilitate image-guided radiation therapy should be aware that this is a relatively safe and well-tolerated procedure with some minor side effects. However, as with having a biopsy, it is not a completely benign procedure. It is a form of surgery, and significant side effects can occur in a small minority of prostate cancer patients.