Practice of Fiducial Marker in Prostate Cancer: A Single-Center Experience with up to 6 Years’ Follow-up Results

  • Cenk Ahmet Sen Asst.Prof.,MD, Department of Radiation Oncology, Izmir University of Economics Faculty of Medicine
  • Mustafa Agah Tekindal Assoc. Prof.,MD, Department of Biostatistics, Izmir Katip Celebi University Faculty of Medicine
Keywords: Fiducial markers, prostate cancer, radiotherapy


We aimed to evaluate the long-term follow-up results of patients with prostate cancer implanted with ultrasound-guided fiducial marker(FM). Forty patients, between 2012-2017 were evaluated. Firstly, the gastrointestinal-genitourinary system side effects were questioned twice immediately after FM implant and in the median 6.5th year and the grading was performed via the NCI CTCAE-V5.0 test and compared. Secondly, in the late period, questions assessing genitourinary-gastrointestinal symptoms were asked using the EORTC QLQ-PR25 Module,and the complication status and patient comfort were assessed The mean symptom value for all patients in the EORTC QLQ-PR25 module was 17,33%. In the first assessment made according to the results obtained by questioning the genitourinarygastrointestinal symptoms related to the FM procedure both after the procedure and in the median 6.5th year,rectal bleeding was present in 2(4%),dysuria 3(6%),hematuria 5(11%) and frequency of urination in 5(11%) patients and in the second assessment,no new symptoms were added and the overall symptom rate decreased. In the first assessment,it was determined via NCI CTCAE-V 5.0 scale that the adverse effects of 9 patients (20%),who were identified with adverse effects,were grade 1 corresponding to mild side effects,and none of the patients experienced grade 2 or higher adverse events. In the second assessment,side effects were defined in 3 patients (7,5%) and grade 1 was mild. The ultrasound-guided FM implant procedure,which is used in prostate cancer radiotherapy is an easy,tolerable and safe technique that does not lead to adverse effects and loss of comfort in patients with long-term follow-up


. Pollack A, Zagars GK, Starkschall G, et al. Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 2002;53(5):1097-105.

. Peeters ST, Heemsbergen WD, van Putten WL, et al. Acute and late complications after radiotherapy for prostate cancer: results of a multicenter randomized trial comparing 68 Gy to 78 Gy. Int J Radiat Oncol Biol Phys 2005;61(4):1019-34

. Michalski JM, Moughan J, Purdy J, et al. Effect of Standard vs Dose-Escalated Radiation Therapy for Patients With Intermediate-Risk Prostate Cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial. JAMA Oncol. 2018;4(6): e180039.

. Barelkowski T, Wust P, Kaul D, et al. M. Image-guided dose-escalated radiation therapy for localized prostate cancer with helical tomotherapy. Strahlenther Onkol. 2020;196(3):229-24

. Zelefsky MJ, Fuks Z, Happersett L, et al. Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol 2000;55(3):241-9

. Langenhuijsen JF, van Lin EN, Kiemeney LA, et al. Ultrasound-guided transrectal implantation of gold markers for prostate localization during external beam radiotherapy: complication rate and risk factors. Int J Radiat Oncol Biol Phys. 2007;69(3):671-6.

. Igdem S, Akpinar H, Alço G, et al. Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity. Br J Radiol. 2009;82(983):941-5

. Lundqvist M, Levin LÅ. Cost-Effectiveness of the Use of Gold Anchor™ Markers in Prostate Cancer. Cureus. 2020 Oct 29;12(10).e11229

. Brown A, Pain T, Preston R. Patient perceptions and preferences about prostate fiducial markers and ultrasound motion monitoring procedures in radiation therapy treatment. J Med Radiat Sci. 2021;68(1):37-43.

. Henry AM, Wilkinson C, Wylie JP, et al. Trans-perineal implantation of radio-opaque treatment verification markers into the prostate: an assessment of procedure related morbidity, patient acceptability and accuracy. Radiother Oncol. 2004;73: 57-9.

. De Cicco L, Bracelli S. Fiducial markers implantation for prostate image-guided radiotherapy: a report on the transperineal approach. Radiol Med. 2019 Feb;124(2):132-35

. Sen CA. Our experiences and suggestions with PEEK marker use in prostate cancer radiotherapy. Contemp Oncol (Pozn). 2018;22(1):47-9.

. Gill S, Li J, Thomas J, et al. Patient-reported complications from fiducial marker implantation for prostate image-guided radiotherapy. Br J Radiol. 2012;85(1015):1011-7

. Lips IM, Dehnad H, van Gils CH, et al. High-dose intensity-modulated radiotherapy for prostate cancer using daily fiducial marker-based position verification: acute and late toxicity in 331 patients. Radiat Oncol. 2008; 3:15

. Available from:URL:

. Available from:URL:

. Zelefsky MJ, Kollmeier M, Cox B, et al. Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012;84(1):125-9.

. Ghanem AI, Elsaid AA, Elshaikh MA, Khedr GA. Volumetric-Modulated Arc Radiotherapy with Daily Image-Guidance Carries Better Toxicity Profile for Higher Risk Prostate Cancer. Asian Pac J Cancer Prev. 2021;22(1):61-8.

. Poźniak-Balicka R, Chomiak B, Wośkowiak P, Nowicki N, Bojarski J, Salagierski M. Does the radiation approach affect acute toxicity in prostate cancer patients? A comparison of four radiation techniques. Cent European J Urol. 2020;73(3):295-9

. Mazzeo E, Triggiani L, Frassinelli L, et al. How Has Prostate Cancer Radiotherapy Changed in Italy between 2004 and 2011? An Analysis of the National Patterns-Of-Practice (POP) Database by the Uro-Oncology Study Group of the Italian Society of Radiotherapy and Clinical Oncology (AIRO). Cancers (Basel). 2021;13(11):2702.

. Zapatero A, Roch M, Büchser D, et al. Reduced late urinary toxicity with high-dose intensity-modulated radiotherapy using intra-prostate fiducial markers for localized prostate cancer. Clin Transl Oncol. 2017;19(9):1161-7

. Lacetera V, Cardinali M, Mantello G, et al. Prostatic fiducial markers implantation by transrectal ultrasound for adaptive image guided radiotherapy in localized cancer: 7-years experience. Arch Ital Urol Androl. 2014;86(4):349-52.

. Kably I, Bordegaray M, Shah K, et al. Single-center experience in prostate fiducial marker placement: technique and midterm follow-up. J Vasc Interv Radiol. 2014;25(7):1125-32.

. De Cicco L, Bracelli S. Fiducial markers implantation for prostate image-guided radiotherapy: a report on the transperineal approach. Radiol Med. 2019;124(2):132-5.

. van Andel G, Bottomley A, Fosså SD, et al. An international field study of the EORTC QLQ-PR25: a questionnaire for assessing the health-related quality of life of patients with prostate cancer. Eur J Cancer. 2008;44(16):2418-24.