At GenesisCare, we specialise in advanced techniques that are designed to be safe and effective and minimise side effects to the bladder and the bowel for patients undergoing prostate cancer radiotherapy. These include the use of prostate spacers to protect the rectum by moving it away from the prostate gland during radiotherapy and fiducial markers. Both the fiducial markers and rectal spacer are inserted in a one-off procedure under local anaesthetic at our outpatient centres prior to treatment.

Three fiducial markers are inserted into your prostate during this procedure. Because they’re clearly visible on your planning CT scan, it enables the radiographer to identify exactly where your prostate is each day. This helps improve the accuracy of treatment and minimises the amount of radiotherapy to surrounding healthy organs, reducing side effects.

We design our care to help give you the best possible life outcomes. This is why we include fiducial markers for patients undergoing 5 fraction stereotactic ablative radiotherapy (SABR) for prostate cancer, with the exclusion of those receiving prostate radiotherapy using on our MRIdian technology.

In some cases, you may have fiducial markers without a prostate spacer or no fiducial markers and just a spacer, but your consultant will always explain this to you. 

During the insertion procedure, three fiducial markers are inserted into the prostate. Before each of your treatments you’ll have a scan where the radiographer reviews the position of the fiducial markers and compares it with the position of the markers on your planning CT scan, together with the position of organs located near the prostate. If there’s any difference, the treatment couch is adjusted before the treatment is given. This enables the radiation to target the tumour more accurately, reducing toxicity to surrounding healthy organs.  

Fiducial marker insertions are routinely performed under local anaesthetic (sometimes under general anaesthetic) by our urologists at a number of our outpatient centres.

The insertion process usually takes 10 minutes.

• Our team will check your current health and will give you an antibiotic to decrease the risk of any infection
• You’ll need to undress below your waist and lie on your back on the couch
• A local anaesthetic will be applied to the skin of your perineum to numb the area
• An ultrasound probe is inserted into the rectum so your consultant can see your prostate. Three markers are then inserted using a fine needle, passed through the skin of the perinium and guided into the correct position in the prostate using the ultrasound imaging
• During the procedure, your consultant urologist will usually also insert a biodegradable rectal spacer that increases the distance between the prostate and rectum. They’ll let you know if you need this

After your procedure, your care team will check that you’re feeling okay and can pass urine normally before you leave the centre.

After your treatment, the fiducial markers will remain in your prostate. It’s safe for them to stay in your body. You won’t be able to feel them, and they won’t prevent you from doing anything.

Side effects from the insertion of fiducial markers are uncommon but may include:

• Blood from the back passage, usually when bowels are opened
• Blood present in urine
• Blood staining of the semen after ejaculation

These changes can last up to two weeks and are nothing to worry about.

If you develop a fever, shivering, feel generally unwell or have flu-like muscle and joint aches, you should go to your nearest A&E department as soon as possible.