Fiducial markers- are they necessary?

@jeffmarc

When we had consultations with RO for possible adjuvant, we were told that my husband would have gold markers inserted to make radiation more targeted. Since gland was removed they wish to mark the place where cancer cells would most probably be - like anastomosis , etc. They are inserted by urologist.

I thought the fiducial markers were necessary due to potential small shifts of the prostate within the body.

@villageidiot It's reasonable for us to think this way. The way I understood it, the prostate is kind of floating, i.e., not anchored in a fix position. In each radiation treatment, it could shift into a position a bit different from where it was during (in my case) MRI-Guided radiation planning. Hence, the need for a mini-CT scan to be compared with the planning images, before starting each of my treatments last April. I cannot speak for the procedures in other cancer centers, but so far I'm satisfied with mine.

During April-May 2021 (at 65y), I had 28 sessions of proton radiation + SpaceOAR Vue. I did not have fiducial markers; I did have the custom body form (called Vac-lok). I also had the tattoos.

These indelible tattoo marks were permanent during the radiation treatment and were used to initially position me in correct alignment. The tattoo marks were not necessarily placed at the location of the targeted tumor. The marks were placed on anatomic landmarks that allow the radiation therapists to initially position me correctly on the machine each day. (Then the table moved with 6-degrees of freedom for more accurate alignment.)

Are you considering EBRT and Proton? I got the markers for my salvage radiation. My buddy doing Proton got the body positioner.

No fiducial markers here, just three permanent dot tattoos that were used each of my 5 sbrt sessions for the initial alignment on the gantry table, then the MRIdian linac took over each time.

@chippydoo

Chippydoo - did you get gold markers ? How are they inserted ? Through perineum area ?
Thanks for the info in advance : )

I got my first ever tattoo's for EBRT lol. I think gold markers are for HBRT (high blast) which my neighbor got. If he has to undergo radiation can he opt for Proton? I've herd it is easier on the body due to being a more precise beam with less good tissue damaged. Many more sessions though. I would gladly trade more sessions for fewer side effects. Does your guy have to undergo salvage and ADT?

@chippydoo
My guy was considering adjuvant ( his PSA is undetectable but high risk case) so RT suggested gold markers for IMRT if we wish to peruse that path. We are still undecided since most suggested not to 🤷‍♀️ and to wait for salvage or very early salvage so we shell see. However I want to be ready for anything in the future since we were blindsided TWICE with PC *sigh . I did not ask about technique used for placement and do not want to send questions - I think that they had enough of me for this year 😋- BUT not my fault actually. I wish I did not have to pull their sleeve to get deserved answers lol.

@surftohealth88 Frankly I didn't realize they use Fiducial markers if you don't have a prostate. They can do an overlay without pins. Most people freak and scan at .2 and often come up zero lights so they carpet bomb the area which is what I did. I would say live your best life one day at a time as if he is cancer free and then take action if he pops a number . The side effects of radiation can be terrible and stay with you the rest of your life. I still have them 8 months after radiation. Somewhat diminished but can still be problematic. Much worse than the RP. Don't miss the gifts of today by worrying about tomorrow which isn't promised. Best wishes, Chip