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Ok, this is getting clearer to me. So when the MRIdian system delivers the photon beams to the tumor they are then stopped upon reaching the 2mm margin? Also, is this 2mm margin established at any given point around the entire tumor via the mapping process? Then there's the subject of fiducial markers. I've read that sometimes they are used and sometimes not. One article even mentioned the use of permanent ink markers (a black Hilighter pen??) On the mskcc.org website it describes the entire nasty procedure. Sounds like a probe with a needle is inserted into the rectum and then the needle passes through the rectal wall to access the prostate to place the markers. Is this your understanding? Seems like it would make more sense to make the trip up through the perineum to avoid the chances of infection in the rectum. Then don't forget the SpaceOar hydrogel which may be given using a needle which is inserted up through the perineum. After all of this rooting around prep work will there be anything left of my prostate? Just give me a silver bullet to bite down on!!
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My SBRT treatment at Mayo used 3mm margins. The prep was placement of 4 gold seed fiducial markers and the SpaceOAR via a transperineal approach all while I was under general anesthesia in an OR. It was pretty much a non-event although I can't imagine doing it under just local anesthesia in a doctors office. The "ink markers" you are referring to are applied on the external skin in three areas during the "simulation" which is when they take precise imaging and measurements to plan the radiation targeting (about 7-10 days before your first radiation treatment). I was offered stickers or permanent tattoos. Since I'm a daily lap swimmer, I opted for the permanent tattoos which are three very small dots about the size of a small freckle where nobody is going to see them anyway. This was just a very minor skin prick. So back to the fiducial markers and SpaceOAR-- my RO feels that even with the MRI imaging/tracking, these fixed markers make the process much more precise. And the SpaceOAR, some say it's not needed with the MRI tracking but he's yet to have a single bowel issues arise from radiation when the device was used. Enough said for me. Others will have different experiences and treatment plans but this was mine. Hardest part for me was just the waiting. Best wishes! Reach out if you want to chat.