Fiducial markers

Hello all.

I last posted on March 15, 2018. I received some excellent advice from several members. After much research and discussion with friends, my oncologists and urologist I have opted for Hormone and radiation therapies.  I received my first 4 month Lupron injection yesterday and am scheduled for a radiation class soon. Both my radiation Oncologist and medical ongologist have adviced that implanting fiducial seeds would be dangerous with my Thrombocytopenia even with platelet infusions because my platelets have hit a new low.

Since the fiducial implants are not feasable they both recommend an alternative procedure that allows them to do external body markers. They will use Daily 'Cone Beam CT' scans to locate and treat the prostate tumor during the radiation. They will be using Image guided radiation. 

Has anyone had this alternative to fiducial markers ever performed. I am very concerned and this appears to be my only option.  I find very limited information on line. I have not heard of anyone having radiation without the markers implanted. My RO says this application is done only for patients that cannot tolerate implantation and he has done them before with similar success to fiducials.

I hope someone can provide some advice on this. Thanks in advance



  • VascodaGama
    VascodaGama Member Posts: 3,491 Member
    Markings for RT alignment

    For those interested in your story, here is the link;

    Treatments are done with the intent of cure but they also aim in minimizing damage or side effects that would prejudice the quality of life of the patient. Without fiducials to guide the radiation beam doctors use other forms of markings (tattoos, x-rays, etc) or widen the field of radiation to assure hitting the target (wider probabilities to affect benign tissues). The Cone Beam CT is good in distinguishing bone from tissue but it is not perfect to distinguish a single tissue among others (prostate, bladder, colon, lymph nodes, etc). However, the CBCT is surely better than simple markings (tattoos on the skin) because it identifies displaced organs that move daily. It provides higher confidence to the radiologist in doing his job.

    The RO treating you seems having due experience in treating with the use of CBCT. It may be a good shot if the protocol includes considerations to your age and other illnesses.

    Best wishes and luck in your journey.


  • silvrado40
    silvrado40 Member Posts: 9

    Thanks again for your input. I am very comfortable with this RO. He spent an hour with my wife and I on our last appointment answering the numerous questions we had. I feel confident that considering my situation he is recommending and choosing the best option for me. I will proceed and pray for the best even though I cannot help but feel like I am in a tiny minority without the implanted markers. 

    I was hoping someone in this forum had undergone something similar.


    Thank you so much


  • Josephg
    Josephg Member Posts: 317 Member
    No Fiducial Implants


    I believe that I received the same or similar radiation therapy that you will be receiving.  I never had any fiducial implants, in fact, it never even came up in conversation.  I never questioned the process, as the radiation therapy was being overseen by a world renown cancer institution.  I received 3 tiny tatoos prior to the beginning of the radiation therapy.  Subsequently, at the beginning of each radiation treatment session, they lined up the tatoos with lasers, when they first placed me on the machine's table.  Once I was lined up by the tatoos, the medical staff left the room, and from another room behind the wall/window of the treatment room, they made additional very fine/minor adjustments in the machine's bed position (you could feel the minor positional movements of the bed), presumably being guided by some scanning methodology incorporated into the overhead assembly of the machine.  Once the minor positional adjustments were completed, the main assembly of the machine over top of me rotated to another head that actually delivered the radiation, and the series of zap/rotate iterations began.

    I am fairly certain that the final adjustments were made in real time, while observing my inner organs and tissues positions, as at the beginning of one treatment, they temporarily halted the final bed adjustment process and came into the room and directed me go to the bathroom and try to empty my bowels.  After doing so, I came back to the treatment room, and they were able to successfully complete the final bed adjustments, before delivering the day's radiation dose.

  • silvrado40
    silvrado40 Member Posts: 9
    edited April 2018 #5

    Thank you so much for the detailed information. It helps a lot because according to the RO I will undergo exactly what you have experienced. I took a 4 month hormone injection one week ago. Were you on hormone therapy prior to your radiation treatments? If so did you feel any side effects of the hormone therapy after one week or thereafter? Are you done with the radiation treatments and if so what side effects are you experiencing? Did the daily treatments cause any dibilitating symptoms? I appreciate your input very much and I am relieved that someone else is having radiation without implanted markers. Thank you for any other information and advice you can provide. I am so grateful to you.

  • Old Salt
    Old Salt Member Posts: 899 Member
    Hormone therapy side effects

    Hormone therapy side effects are many and vary a lot. Hot flashes, tiredness and weight gain are common, but some also complain about 'brain fog'. Interest in sex will vanish once the testosterone gets low. Having a positive outlook and staying active (exercise!) are highly recommended to counteract these effects.

    In general, the daily radiation sessions are short and easy to take. Perhaps some tiredness at some point. 

    Hopefully, others will expand on this.

  • silvrado40
    silvrado40 Member Posts: 9

    Thank you for the information. Now a full week after my first lupron injection. Your information will help me prepare for side effects.  I stay active and have a home gym. I walk three miles every day and hope to be able to continue through the radiation. I still wonder how long before the lupron side effects start. I'm glad to hear the radiation sessions appear to be tolerable. Thanks again.

  • Josephg
    Josephg Member Posts: 317 Member
    edited April 2018 #8
    Hormone and Radiation Therapy Experiences

    Hi Silvrado40,

    I have reported on my hormone and radiation therapy experiences in this forum.  Please check out the link below for details of my experiences, titled Salvage Treatment.

    I wish you the best of outcomes on your journey.

  • silvrado40
    silvrado40 Member Posts: 9

    Read your post. Thank you for sharing your experience.