Transperineal Insertion of Gold Seeds and Spaceoar

This is almost identical to the transperineal biopsy of the prostate which was performed to diagnose prostate cancer previously.  The gold seeds will assist the radiation oncologist in accurately targeting the prostate as well as minimizing the radiation dose to the nearby rectum.

Gold seeds

Gold seeds are markers seen on an x-ray to assist the radiation oncologist in localizing the prostate gland. This enables accuracy when delivering the radiation treatment. The prostate is a mobile pelvic organ and can be clearly seen on daily imaging, which enables advanced radiation treatments with confidence.

These seeds are not radioactive. The gold seeds are made of gold or platinum and will stay in your prostate permanently. They are smaller than a grain of rice.

SpaceOAR Hydrogel

The SpaceOAR is an absorbable water-based gel that temporarily creates a space between the prostate and the rectum, protecting the rectum from radiation exposure during prostate radiatiotherapy. The prostate and rectum are very close and are naturally separated by a small space.

The hydrogel stays in the body for about 3 months and is naturally absorbed in about 6 months, well after the last radiation treatment

Before the procedure

Please inform your doctor or specialist nurse if you are

  • taking any blood thinning medications such as aspirin, warfarin, clopidogrel, rivaroxaban or dipyridamole
  • have bleeding problems
  • have allergies to any medications, including anaesthetic
  • have an artificial heart valve

You should continue to take all of your medications as normal, unless you have been told otherwise by the doctor who organised your procedure.

This procedure is performed as a day case, which means you will be able to come in to hospital, have the biopsy and leave on the same day. The hospital will usually call the day before to tell you when to fast and come into the hospital

If you are having a general anaesthetic, medication will be administered through a small needle inserted into the back of your hand. This will make you sleep for the whole procedure, so you will not feel any pain or discomfort. You will wake up in the recovery room and your surgeon will see you prior to discharge.

What are the risks?

The risks are almost identical to transperineal biopsies of the prostate

  • Blood in the urine (haematuria) can range from peachy coloured urine to even claret coloured. It is rarely a sign of a serious problem. Increasing your fluid intake will usually help clear any bleeding. However, if there is persistent or heavy bleeding every time you pass urine you should go to your nearest Emergency department.
  • There can be difficulty passing urine as the prostate swells after the biopsy. It is common if your prostate is already enlarged and you have pre-existing lower urinary symptoms (LUTS). If you cannot pass urine at all, please attend your nearest emergency department in case a catheter is required to drain the bladder.
  • Infection is rare after this procedure. Nevertheless, antibiotics are given at the time of the procedure as well as on discharge. If you develop a fever, chills, uncontrollable shaking (rigors) or burning when passing urine, you may have an infection and should seek medical attention. Please attend Lake Macquarie Private Hospital Emergency if insured or your nearest emergency department if this occurs.  Our specialist urology nurses are usually available for phone advice during working hours.