La radiologia medica

, Volume 124, Issue 2, pp 132–135 | Cite as

Fiducial markers implantation for prostate image-guided radiotherapy: a report on the transperineal approach

  • Luigi De CiccoEmail author
  • Stefano Bracelli



In the external beam prostate cancer radiation therapy, daily gland displacement could lead to a target missing. The use of intra-prostatic gold fiducial markers for daily prostate position verification and correction before and during treatment delivery (image-guided radiotherapy, IGRT) is widely used in the radiation therapy centers to accurately target the prostate. Usually, the fiducial markers are implanted through the rectum, with complications such as infections and rectal bleeding. We report our experience in prostate fiducial markers implantation through a transperineal approach.

Patients and methods

Between September 2011 and January 2018 at our center, 101 patients underwent gold seed fiducial marker transperineal ultrasound-guided implantation for prostate IGRT. We retrospectively reviewed their features and outcome. Twenty-two (21.8%) patients had previously been subjected to a transurethral prostate resection (TURP) for obstructive urinary symptoms because of benign prostatic hypertrophy. No antibiotic prophylaxis was used.


The procedure was well tolerated. In one patient, a single episode of self-limiting urinary bleeding occurred just after it. No other complication was recorded. All the patients, at the evaluation before discharge, reported no pain or dysuria. No rectal bleeding, hematospermia, urinary obstruction or infection were reported in the next days. No markers lost or migration occurred.

Discussion and conclusion

According to our experience, prostate fiducial markers implantation through a transperineal approach is safe and should be recommended to limit the use of antibiotic therapy and patients morbidity. A previous TURP was not related to a higher risk of loss of seeds.


Prostate cancer Radiotherapy Fiducial markers Image-guided radiotherapy Prostate radiotherapy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This is a retrospective study. For this type of study, formal consent is not required.


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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyASST della Valle OlonaBusto ArsizioItaly

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