PV QA 1 - Poster Viewing Q&A 1
SU_22_2229 - Transperineal Gold Marker Implantation Prior to SBRT for Prostate Cancer: A Single Institution Prospective Study to Minimize Patient Discomfort
Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3
Transperineal Gold Marker Implantation Prior to SBRT for Prostate Cancer : A Single Institution Prospective Study to Minimize Patient Discomfort
S. R. Blacksburg, T. J. Carpenter, S. Carbone, K. Flood, K. Maloney-Lutz, A. Mirza, G. Demircioglu, and J. A. Haas; NYU Winthrop Hospital, Mineola, NY
Purpose/Objective(s): Patients treated with robotic-based Stereotactic Body Radiation Therapy (SBRT) for prostate cancer require implantation of fiducial markers to provide inter and intrafraction translation and rotation adjustment. While both transrectal and transperineal techniques are employed, trade-offs include risk of infection, bleeding, and pain. The goal of this study was to characterize patient discomfort during the office procedure, and to prospectively assess the effect oral benzodiazepine and/or transperineal lidocaine has on patient symptoms.
Materials/Methods: Between December 26, 2017 and February 9, 2018, 45 consecutive patients with localized prostate cancer underwent transperineal fiducial marker implantation at our institution. Prior to marker implantation, all patients had EMLA cream applied to their perineum and topical lidocaine applied intrarectally. Patients could elect for oral benzodiazepine and/or bilateral injection of 5cc’s 1% transperineal lidocaine prior to the procedure. 4 fiducial markers were implanted for each patient. The mean patient age was 67.3 (50-81) and the mean prostate size was 47.1cc’s (15-115). 12 (26.7%) patients had an intravesical (median lobe) component. 20 (44.4%) patients received transperineal lidocaine injection and 17 (37.8%) ingested ativan or xanax prior to the procedure. Pain was scored on a 0-10 analog scale, where a score of 0 meant “no pain” and a score of 10 represented “unbearable pain.” Patients assigned scores to their pain for both the rectum (probe) and perineum (needles).
Results: The mean rectal and perineal pain levels were 4.7 (± 2.7) and 5.0 (± 2.6), respectively. 9 (20%) patients characterized the rectal pain as at least an 8 and 6 (13.3%) patients characterized the perineal pain at this level. Mean perineal pain was lower for patients who elected for transperineal lidocaine (4.2 vs. 5.8, p=.034), representing a 27.6% reduction. Patients younger than age 65 reported higher rectal pain levels (5.94 vs. 3.89, p=.012) during the procedure. There was strong correlation between rectal and perineal pain scores (+0.48, p<.001). Oral benzodiazepine use, ethnicity, presence of a median lobe, and prostate size did not predict for perineal or rectal pain. No procedures were aborted and there were no procedure complications.
Conclusion: Transperineal gold marker implantation is a well-tolerated office procedure. Patient reported rectal and perineal pain levels are measurable and, though correlated, they differ. Providing transperineal lidocaine significantly reduces perineal pain associated with fiducial placement.
Author Disclosure: S.R. Blacksburg: None. T.J. Carpenter: None. S. Carbone: None. K. Flood: None. J.A. Haas: Consultant; Accuray.