MP05-18 PROSTATE FIDUCIAL MARKER PLACEMENT IN PATIENTS WHILE ON ANTICOAGULATION: FEASIBILITY PRIOR TO PROSTATE SBRT

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy I1 Apr 2017MP05-18 PROSTATE FIDUCIAL MARKER PLACEMENT IN PATIENTS WHILE ON ANTICOAGULATION: FEASIBILITY PRIOR TO PROSTATE SBRT Jonathan Haas, Aaron Katz, Joshua Harris, Todd Carpenter, Susan Carbone, Thomas Kole, Steven Pristupa, Matthew Witten, and Seth Blacksburg Jonathan HaasJonathan Haas More articles by this author , Aaron KatzAaron Katz More articles by this author , Joshua HarrisJoshua Harris More articles by this author , Todd CarpenterTodd Carpenter More articles by this author , Susan CarboneSusan Carbone More articles by this author , Thomas KoleThomas Kole More articles by this author , Steven PristupaSteven Pristupa More articles by this author , Matthew WittenMatthew Witten More articles by this author , and Seth BlacksburgSeth Blacksburg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.177AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fiducial marker placement is required in patients undergoing robotic-based Stereotactic Body Radiotherapy (SBRT) for prostate cancer in order to track the six degrees of prostate motion that occur intrafractionally, during treatment. Many patients take anti-coagulant medication due to other comorbidities. Anticoagulation therapy can cause patients to bleed during procedures and, in general practice, are often temporarily discontinued prior to invasive medical procedures to reduce that risk. Some patients may not be able to temporarily discontinue anticoagulation therapy due to an increased risk of a thromboembolic event from their comorbid medical conditions. METHODS From August 2015-October 2016 23 consecutive patients on chronic anticoagulation therapy who were not cleared to stop these medications underwent TRUS-guided fiducial marker placement for SBRT/Image Guided Radiation Therapy. The reasons for patients being on anticoagulation therapy were recent stent placement (11,) myocardial infarction (7,) atrial fibrillation (3,) and pulmonary embolus (2.) The anticoagulation consisted of Plavix (9,) Aspirin (7,)Coumadin (3,) Lovenox (2,) Eliquis (1,) Brillinta (1,) Pradaxa (1,) and Effient (1,) All patients received 4 fiducial markers placed under Transrectal ultrasound guidance (TRUS.) EMLA Cream and lidocaine gel were used to numb the perineum and rectum. 2 needles each double loaded with 2 gold fiducial markers with a spacer in between were placed transperineally into the prostate. 2 fiducial markers were placed at the right and left base and 2 fiducial markers were placed at the right and left apex. Patients had a CT scan after procedure to confirm ideal geometry of the marker placement. The needles were withdrawn as was the ultrasound transducer. Gentle pressure was applied by the nursing staff. All patients were monitored for bleeding afterwards by a registered nurse. RESULTS All 23 patients who were on anticoagulation and underwent fiducial marker placement were discharged home the same day of the procedure. No patient experienced significant bleeding in the peri-procedural window and no patient had any untoward cardiovascular event. CONCLUSIONS This series suggests active anticoagulation is not an absolute contraindication to fiducial marker placement in patients undergoing SBRT or IGRT for prostate cancer. Transperineal fiducial marker placement appears to be safe in patients on active anticoagulation medication. These patients should be closely monitored after the procedure for bleeding complications. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e44-e45 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jonathan Haas More articles by this author Aaron Katz More articles by this author Joshua Harris More articles by this author Todd Carpenter More articles by this author Susan Carbone More articles by this author Thomas Kole More articles by this author Steven Pristupa More articles by this author Matthew Witten More articles by this author Seth Blacksburg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...