Trans Rectal Ultrasound and Fiducial Marker (gold seeds) Implantation

Tiny gold seeds that show up on x-ray are now being used by Radiation Oncologists to improve the accuracy of radiation delivery.

This procedure involves the examination of the prostate by an ultrasound inserted into the rectum. After local anaesthetic has been injected three needles are inserted and the gold seed markers are placed within the prostate. This procedure is uncomfortable but not usually painful, similar to the prostate biopsy procedure.

Allow a total appointment time of 30 minutes, although the procedure itself normally takes 10 minutes.

Before the procedure

  • Do not take aspirin or anti-inflammatory medications for 7 days before the procedure. This will reduce the risk of bleeding.
  • Please advise your doctor if you are taking Warfarin or any blood thinners as he will need to discuss this with you.
  • A single antibiotic tablet (Ciproxin) is used before and after the procedure to significantly diminish the risk of infection.
  • A microlax enema may be used prior to the procedure if ordered by your doctor.
  • Antibiotic (Ciproxin) Tablets:
  • In line with infection control guidelines, we recommend antibiotic treatment to minimise the risk of infection.
  • You will be supplied with two antibiotic tablets.
  • The first tablet should be taken one and a half hours (90 minutes) before your appointment. You should have nothing to eat for two hours before and after your tablet. You may drink water if you are thirsty.
  • Take your second antibiotic tablet approximately two hours following your evening meal. After your meal only drink water if you are thirsty.

During the procedure

  • You will be escorted to theatre and asked to change.
  • The procedure is carried out with you lying on your left side in a similar position to a rectal examination.
  • The ultrasound probe is inserted into your rectum.
  • Local anaesthetic is injected around the prostate to make the procedure more comfortable.
  • The three gold seed markers are then inserted into your prostate.
  • It is important to lie as still as possible and let the doctor know if the procedure is painful.

After the procedure

  • A sick certificate will be arranged if requested.
  • Limit your activities and rest for 24 hours.
  • You should be able to resume normal activities the following day.
  • Refer to your Radiotherapy Information Sheets for further instructions regarding your radiotherapy treatment plan.

Risks and complications

Infection

If you feel unwell with a headache, sweating, fevers, chills, painful testicles or problems passing urine, you need to contact your Urologist immediately as you may require admission to hospital for further treatment.

Bleeding

You may experience blood in your urine, bowel motion and semen and this will gradually subside over the next few days and rarely causes a problem. If bleeding persists or is very heavy, contact your doctor.

Inability to urinate

This can occur due to swelling around the prostate and may rarely lead to a complete blockage of urine flow. If this occurs, contact your doctor.

Pain and discomfort

You may experience discomfort in the rectum or base of the penis. This is very common and should settle within 48 hours.