After it has been decided that external beam radiation therapy is the best treatment option, an appointment will be made for gold fiducial seed placement in the patient’s prostate gland. Each gold fiducial seed is about the size of a grain of rice. They are not radioactive, they are MRI safe, and are intended to stay in your body permanently. They are placed to assist the radiation oncologist in identifying the prostate gland prior to each treatment. The procedure is done at the Austin Center for Radiation Oncology and takes approximately 10 to 15 minutes. It is very similar to the prostate biopsy but only involves three needle punctures. Only local anesthesia is necessary. Please allow an hour at the radiation center for check-in, the procedure and recovery.

Prior to gold fiducial seed placement, you will need to do the following:

• Stop blood thinners one week (five days) before this procedure. If you are on Eliquis (Apixaban), Pradaxa (Dabigatran) or Xarelto (Rivaroxaban) you may stop them three days prior to your appointment. The risk of blood thinning agents or anticoagulants is significant. Please notify your physician if you take any medications containing Aspirin, non-steroidal anti-inflammatory agents such as Ibuprofen, Naproxen, Advil or Motrin. You should also stop Vitamin E, Fish Oil, Plavix, Coumadin and other blood thinners.
• You will need to use two “Fleet” enemas. The first one needs to be done three hours before bedtime, the day before your procedure. The second enema should be applied two to three hours before the procedure. Please follow the instructions given with the medication. You may eat breakfast and lunch just as you normally would.
• We will give you an antibiotic in your buttock or thigh prior to the procedure, You should also start your oral antibiotics the day before this procedure. Make sure you pick up your antibiotic prescription from your pharmacy.
• The procedure may cause some discomfort. We will use a topical anesthetic. A narcotic or anti-anxiety pill is not recommended prior to the procedure. This will allow you to drive yourself to and from the procedure.
• You will be able to go home after the procedure, You should limit your physical activity the day of the procedure but may resume your physical activity the next day. The following restrictions apply: no lifting more than 20 lbs., and no sexual activity two days after the procedure. After two days, there are no restrictions.
• There are no dietary restrictions. You may have a normal breakfast, lunch and dinner the day before and the day of the procedure.
• You may experience the following problems after the procedure: bleeding from the rectum; blood in the urine; blood in the semen; burning, pain or frequency during urination. Unless these symptoms persist for more than 24 hours, there is not a reason to be concerned. If you develop fever, chills, excessive bleeding, or if you are unable to urinate, call our office immediately at 512-687-1950. Our after hours phone number is 512-458-1121. If it is a true medical emergency, or you are unable to contact us, go to the nearest emergency room.

If you have any questions about these instructions, contact the Austin Center for Radiation Oncology.