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X-ray prostate with fiducial markers implantes

Prostate

Prostate cancer is the second most common cancer diagnosed in males worldwide. Fiducial markers are often used to guide external beam radiotherapy to provide target coverage while protecting nearby sensitive organs. Traditional markers are, however, implanted with relatively thick needles that can cause infections and bleeding. Traditional markers can also move in the needle tract some days after implantation because the markers have a smaller diameter than the needle tract. Medical teams therefore typically choose to wait 1-3 weeks for the markers to “settle in” before continuing with CT/MR for dose planning.

Gold Anchor’s industry leading thin needles and unique marker design makes it possible to proceed with CT/MR for dose planning on the same day as implantation.

Reduce implantation time

Transrectal

We generally recommend transrectal implementation of Gold Anchors. With Gold Anchors this is a low risk procedure that does not require anesthesia. Three Gold Anchors can typically be implanted by the doctor in less than five minutes.

transrectal

Transperineal

If you prefer to implant markers transperineally you can also avoid anesthesia – using an anaesthetic patch 30 minutes before implantation is enough.

transperineal

Reduce patient discomfort

Intensity of pain during transrectal implantation in prostate (not showing those answering “no pain”).

17G; 1.2x3mm markers
without anesthesia

0 = no pain 5 = worst possible pain

pain_17g

Share of patients (n=135)

18G; 1x5mm markers
with local anesthesia

0 = no pain 5 = worst possible pain

pain_18g

Share of patients (n=229)

22G; Gold Anchor
without anesthesia

0 = pain 10 = worst possible pain

pain_22g

Share of patients (n=362)

Source (17G): Igdem S, Akpinar H, Alço G et al. Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity. Br Radiol 2009;82:941-945.

Source (18G; 1×5 mm): S Gill, J Li, J Thomas, et al. Patient-reported complications from fiducial marker implantation for prostate image-guided radiotherapy. Br J Radiol. 2012 Jul;85(1015):1011-7.

Source (22G): Wioletta Mista, Leszek Miszczyk. An evaluation of side effects after gold markers (Gold Anchor™) implantation to prostate gland in patients with prostate cancer. Onkologia Info 2011;8;2:110-111.

Reduce complications from implantation

Graph of Urinary Tract Infection compared with other fiducial markers

Gold Anchors can be implanted transrectally in prostate with a very low risk of infection vs. other transrectal procedures, see graph.

These results from Karolinska suggest that the thin Gold Anchor needles reduce the risk of UTI despite the use of only a single dose of non-broadspectrum antibiotics as prophylaxis. 

“The application process for Gold Anchor is much easier than for other fiducial markers. With Gold Anchor we do not have to use local anesthesia – giving local anesthesia would be more painful than implanting the fine needle marker.

We have between 5-8 patients per week and have had almost no infections since we started using Gold Anchors in 2009 [see graph above].” 

Oncologist Enrique Castellanos

MD, PhD, Department of Oncology, Karolinska University Hospital, Sweden

Save lead time and travel

With Gold Anchor there is no need to wait the usual 7-21 day before dose planning. The thin Gold Anchor needle, that causes minimal bleeding and swelling, in combination with the strong tissue attachment of the marker, makes it possible to proceed with CT and/or MR for dose plan on the same day as implantation.

Note: Most centers that use traditional markers send their patient home for 7-21 days after implantation to allow the traditional markers to “settle in”, i.e. to allow the potential bleeding and swelling subside to reduce the risk that the traditional markers migrate in the tissue.

graph saving leadtime compared to traditional fiducual marker

“We use two Gold Anchors per patient – one with line shape and one with ball shape. We have never seen any events of infection.

When we use these very thin needles we have stopped to give local anaesthesia – the tiny needles are usually tolerated very well by the patient. Instead we use a small EMLA patch.

We do the CT planning on the same day as the gold marker implantation.”

Bengt Johansson

MD, PhD, Dept. of Oncology, Örebro University Hospital, Sweden

Great visibility for prostate

Thin marker in unique material

Gold Anchor is made of an alloy of pure gold and 0.5% pure iron for improved MR visibility. The marker is only 0.28 or 0.40 mm thick, wich improves the surface-to-volume ratio. Read more about our great visibility.

Benefits:

  • Reduce CT artifacts
  • Easily register CT and MR images
  • Clearly visible on kV and ultrasound
  • Ideal for Proton therapy