Feasibility Of Transrectal And Transperineal Fiducial Marker Placement For Prostate Cancer Before Proton Therapy

Background: To compare the feasibility of transrectal and transperineal fiducial marker placement for prostate cancer before proton therapy.Materials and Methods: From 2013 to 2015, the first 40 prostate cancer patients that were scheduled for proton therapy underwent transrectal fiducial marker placement, and the next 40 patients underwent transperineal fiducial marker placement (the first series). Technical and clinical success and pain scores were evaluated. In the second series (n = 280), the transrectal or transperineal approach was selected depending on the presence/absence of comorbidities, such as blood coagulation abnormalities. Seven patients refused to undergo the procedure. Thus, the total number of patients across both series was 353 (262 and 91 underwent the transrectal and transperineal approach, respectively). Technical and clinical success, complications, marker migration and the distance between the two markers were evaluated.Results: In the first series, the technical and clinical success rates were 100% in both groups. The transrectal group exhibited lower pain scores than the transperineal group. The overall technical success rates of the transrectal and transperineal groups were 100% (262/262) and 99% (90/91), respectively (P > 0.05). The overall clinical success rate was 100% in both groups, and there were no major complications in either group. The migration rates of the two groups did not differ significantly. The mean distance between the two markers was 25.6 +/- 7.1 mm (mean +/- standard deviation) in the transrectal group and 31.9 +/- 5.2 mm in the transperineal group (P < 0.05).Conclusion: Both the transrectal and transperineal fiducial marker placement methods are feasible and safe.