Transrectal Ultrasound-Guided Prostate Gold Seed Placement

Transrectal ultrasound-guided prostate gold seed placement is a procedure to place small metal seeds (fiducial markers)in or around a tumor on the prostate. These seeds help show exactly where a tumor is located. This helps guide radiation therapy directly at the prostate tumor, which avoids killing nearby healthy tissue.

During this procedure, a small device (probe) is lubricated and placed inside the rectum. The probe makes sound waves that create a picture of the prostate (transrectal ultrasound). The images will be used to help guide the placement of the gold seeds. This procedure is also called fiducial marker placement.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any medical conditions you have.
• Any blood disorders you have.
• Any surgeries you have had.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs.
• The gold seeds moving to another part of the body. This is rare.

What happens before the procedure?

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may be given antibiotic medicine to help prevent an infection.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• If you were asked to do a bowel prep before your procedure, follow instructions from your health care provider about how to do this.
• You may have a blood sample taken.
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• Monitors may be placed on your body to track your heart rate, blood pressure, and breathing.
• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• A lubricated probe will be inserted into your rectum to perform the ultrasound.
• You will be placed on your left side with your knees bent up toward your chest.
• Using the ultrasound as a guide, the health care provider will insert a needle between your rectum and scrotum and will place it near the tumor.
• The needle will inject the gold seed into the area around the tumor. This will be repeated with two more gold seeds. More seeds may be added depending on the size and location of the tumor.
• The needle and probe will be removed.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You may have imaging tests done to check the placement of the gold seeds. This may include a CT scan or ultrasound.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will continue to be monitored until the medicines you were given have worn off.
• Do not drive for 24 hours if you were given a sedative.
• You will be given medicine to help with pain, if needed.

What are the complications of Transrectal Ultrasound-Guided Prostate Gold Seed Placement?

• Transrectal gold marker implantation for prostate position verification is safe and appears to be a well-tolerated procedure.
• In only 1.9% of the studied patients were minor voiding complaints observed.
• Other minor transient complications, defined as hematuria lasting >3 days, hematospermia, and rectal bleeding, occurred in 3.8%, 18.5%, and 9.1% of the implanted patients, respectively.
• These minor bleeding complications were more frequently seen in patients with an advanced tumor stage.

Summary

• This procedure involves placing small metal seeds (fiducial markers) in or around a prostate tumor.
• The gold seeds help guide radiation therapy directly at the prostate tumor, which avoids killing nearby healthy tissue.
• During this procedure, a small probe will be placed in the rectum to take images of the prostate (transrectal ultrasound). The images will help guide the placement of the gold seeds.

Transrectal Ultrasound-Guided Prostate Gold Seed Placement, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Light bleeding from the rectum.
• Bruising or tenderness in the area behind the scrotum (perineum).
• Small amounts of blood in your urine. This should only last for a couple of days.
• Light brown or red semen. This may last for a couple of weeks.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Activity

• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Ask your health care provider when it is safe for you to resume sexual activity.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Drink enough water to keep your urine pale yellow.
• Keep all follow-up visits as told by your health care provider. This is important.

Managing pain, stiffness, and swelling

• If directed, put ice on the affected area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Try not to sit directly on the area behind the scrotum. A soft cushion can help with discomfort.

Contact a health care provider if:

• You have a fever or chills.
• You have more blood in your urine instead of less.
• You have blood in your urine for more than 2–3 days after the procedure.
• You have trouble urinating or having a bowel movement.
• You have pain or burning when urinating.
• You have nausea or you vomit.

Get help right away if:

• You have severe pain that does not get better with medicine.
• Your urine is bright red.
• You cannot urinate.
• You have rectal bleeding that gets worse.
• You have shortness of breath.

Summary

• After the procedure, you may have blood in your urine and light bleeding from the rectum.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Contact your health care provider right away if you have increased bleeding during urination or increased rectal bleeding.