For those who are interested in the preparation that leads to the insertion of the gold seeds, I have included the following.
How it Works
Transrectal prostate fiducial marker gold seed insertion with ultrasound guidance is a method of inserting small gold seeds into the prostate gland using a needle inserted via the rectum/back passage. Three seeds are inserted using a 17G needle and the use of an ultrasound to guide the surgeon to the correct region.
The Radiologist performing the procedure specialises in Prostate procedures, assisted by nursing staff and ultrasound technologists.
Time
The procedure will take about 30 minutes to perform but we will want to observe you following the procedure for 1 hour or so if you are an outpatient, so that you may be at the hospital for a least 2 hours - longer after sedation.
How To Prepare
Before the procedure you should have stopped any tablets or injections that may alter your blood clotting - Heparin and Clexane the day before and Warfarin for 3 days. Clopidogrel, Aspirin and most other anti-inflammatory drugs etc will need to be stopped for 10 days or more. If this has not happened or you have any questions about stopping routine medication, please see your referring doctor or ring us.
Your specialist should arrange oral antibiotics (trimethoprim [Triprim or Alprim] 300 mg at night) for the days before and following the procedure. If you have any symptoms or signs of a urinary tract infection (burning sensation when passing urine etc) please ring us.
If you wish to have strong pain relief or sedation (intramuscular or intravenous), you will need to contact us before the day of your biopsy, stay for 1 or 2 hours longer after the biopsy and have someone take you home if you are an outpatient.
What to Expect
On arrival, you will be given a laxative to empty the rectum. You should also empty your bladder at this time. You will also be given an intravenous antibiotic injection (Gentamicin 240 mg). It is necessary for you to sign a consent form to confirm that you know about the risks and benefits associated with the procedure.
After you are taken to the Ultrasound room your Prostate gland will be clinically examined (as has already been performed by your doctor). The ultrasound probe will then be inserted into your rectum and pictures taken of your prostate gland. Immediately following this, the 3 gold seeds will be inserted. This will be uncomfortable, but is not usually unduly painful. It is very important to stay still. Please do not hesitate to ask us to stop at any point if you do not want us to continue.
Following the ultrasound guided seed placement, plain x-rays of your pelvis will also be obtained.
Side Effects
One of the advantages of performing the procedure under ultrasound guidance is to decrease the risk of damage to adjacent organs; however side effects and complications may still occur from this procedure.
For a day or so following the procedure you may notice MINOR pelvic discomfort or pain. MINOR blood staining of your urine/bowel motions may last for up to a week or so.
For a month or so following the procedure, you may notice blood staining in your ejaculate.
Possible Complications
If any of the following main complications develop:
How it Works
Transrectal prostate fiducial marker gold seed insertion with ultrasound guidance is a method of inserting small gold seeds into the prostate gland using a needle inserted via the rectum/back passage. Three seeds are inserted using a 17G needle and the use of an ultrasound to guide the surgeon to the correct region.
The Radiologist performing the procedure specialises in Prostate procedures, assisted by nursing staff and ultrasound technologists.
Time
The procedure will take about 30 minutes to perform but we will want to observe you following the procedure for 1 hour or so if you are an outpatient, so that you may be at the hospital for a least 2 hours - longer after sedation.
How To Prepare
Before the procedure you should have stopped any tablets or injections that may alter your blood clotting - Heparin and Clexane the day before and Warfarin for 3 days. Clopidogrel, Aspirin and most other anti-inflammatory drugs etc will need to be stopped for 10 days or more. If this has not happened or you have any questions about stopping routine medication, please see your referring doctor or ring us.
Your specialist should arrange oral antibiotics (trimethoprim [Triprim or Alprim] 300 mg at night) for the days before and following the procedure. If you have any symptoms or signs of a urinary tract infection (burning sensation when passing urine etc) please ring us.
If you wish to have strong pain relief or sedation (intramuscular or intravenous), you will need to contact us before the day of your biopsy, stay for 1 or 2 hours longer after the biopsy and have someone take you home if you are an outpatient.
What to Expect
On arrival, you will be given a laxative to empty the rectum. You should also empty your bladder at this time. You will also be given an intravenous antibiotic injection (Gentamicin 240 mg). It is necessary for you to sign a consent form to confirm that you know about the risks and benefits associated with the procedure.
After you are taken to the Ultrasound room your Prostate gland will be clinically examined (as has already been performed by your doctor). The ultrasound probe will then be inserted into your rectum and pictures taken of your prostate gland. Immediately following this, the 3 gold seeds will be inserted. This will be uncomfortable, but is not usually unduly painful. It is very important to stay still. Please do not hesitate to ask us to stop at any point if you do not want us to continue.
Following the ultrasound guided seed placement, plain x-rays of your pelvis will also be obtained.
Side Effects
One of the advantages of performing the procedure under ultrasound guidance is to decrease the risk of damage to adjacent organs; however side effects and complications may still occur from this procedure.
For a day or so following the procedure you may notice MINOR pelvic discomfort or pain. MINOR blood staining of your urine/bowel motions may last for up to a week or so.
For a month or so following the procedure, you may notice blood staining in your ejaculate.
Possible Complications
If any of the following main complications develop:
- Severe infection (symptoms include feeling generally unwell, raised temperature, shivers etc most commonly manifested in the first 24-72 hours.)
- Urinary Retention (inability to pass urine for 8 hours or more.
- Profuse bleeding from the rectum or penis.
Contact your referring specialist IMMEDIATELY and proceed to the Emergency Department.
Infection develops in approximately 1 in 100 procedures and urinary retention/profuse bleeding occur in less than 1 in 1000. Spread of infection to the spine and death from infection is rare.
Afterwards
Following the procedure, for your comfort it is recommended that you should rest for the next 24 hours although you may undertake light activity. You may have minor discomfort over the 24 hours for which you may take paracetamol, but NOT aspirin. Depending on what sort of work you do, you may need to arrange a day’s sick leave.
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