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Failed Barrigel injection and insertion of only 3 of 4 carbon markers
I had a procedure earlier this week in preparation for upcoming 20 sessions of photon beam therapy to (i) insert Barrigel between my prostate and rectal wall; and (ii) insert 4 carbon fiducial markers into the prostate.
I was informed later that day that the surgeon was unable to inject the Barrigel because I had no perirectal fat (one of the cons of a low-fat diet? lol). I obviously want as much protection to my rectum as possible and do not like the probability of having the photon beam treatments with my prostate basically touching my rectal wall. Is there anything that can be done about this?
On the following day after my MRI I read that:
“Three fiducial markers are in place, two on the right and one on the left. The 4th fiducial marker that was placed at the left base is not well delineated.”
It seems that there is a reason that they want 4 markers and not 3 or 5. I am assuming that the most accurate delivery of the radiation occurs when all 4 carbon markers are accurately observed. Is there anything that can be done about this? Can the surgeon insert at 5th marker to take the place of the 4th?
Thanks.
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I also had 4 carbon fiducial markers inserted in the prostate and SpaceOAR (hydrogel) placed. 4 days later an MRI was performed which indicated all were placed as planned. Then about 2 weeks later I had some rectal pain - urologist had me go to Mayo for urine tests, to see if it was causing an infection - but negative. All well for about 2 weeks, then a bit of discomfort and rectal/anal leakage. At this time I had my first of 20 sessions of photon radiology. Urologist had me go to Mayo for CT scan, blood and urine tests. In reviewing, something was not right - some liquid or pus around the hyrdogel, but due to a former total hip replacement - there was shadowing in the images. So doc had me back for MRI which indicated problems - but still unsure what - they thought I should be having infection, but I physically felt OK. After consults (urology, colarectal, oncology radiology) they checked me into hospital and next morning performed ‘exploratory’ surgery (sigmoidoscopy, endoscopy, and needle in perineum to try to extract pus/liquid, but no extraction). Finding was a fistela (pin hole) in rectal wall. Since I had no fever etc, decision was to treat with 3 days of antibiotic coctails in hospital ant then 2 weeks of antibiotics at home - finished yesterday. Will have another MRI in 2+ weeks and then additional consults with urology, colorectal and oncology radiology. Photon radiology has been delayed for 6 months to assure hydragel naturally disolves - and then restart radiology - perhaps with a different gel solution or an updated balloon (stays in). Anybody else have similar situations????
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2 Reactions@daveys That is true. Prior to the approval of SpaceOAR in 2015, endo-rectal balloons were the best they had.