Patient perceptions and preferences about prostate fiducial markers and ultrasound motion monitoring procedures in radiation therapy treatment

Abstract

Introduction Patient experiences and preferences of image‐guidance procedures in prostate cancer radiotherapy are largely unknown. This study explored experiences and preferences of patients undergoing both fiducial marker (FM) insertion and Clarity ultrasound (US) procedures. Methods A sequential explanatory mixed method approach was used. A questionnaire (n = 40) ranked experiences from 0 to 10 (worst) in the domains of invasiveness; pain; physical discomfort; and psychological discomfort. Responses were analysed with descriptive and inferential statistics. Semi‐structured interviews (n = 22) obtained further insights into their perspectives and preferences and were thematically analysed. Results Perceptions of invasiveness varied with 46% reporting FMs more invasive than US and 49% the same for the two procedures. The mean score for FM was 3.6 and 2.1 for US. Mean scores for pain, physical and psychological discomfort were higher for FMs with 3.3, 3.2 and 2.9, respectively, and 1.1, 1.2 and 1.7 respectively for US, only pain achieved significance (P < 0.05). Three themes emerged from the interviews: Expectations versus Experience; Preferences linked to Priorities; and Motivations. Eleven patients (50%) preferred US; however, 10 (45%) could not illicit a preference. Conclusion Participants found both of the FM and US image‐guidance procedures tolerable and acceptable. Men’s preference was elusive, suggesting a more rigorous preference methodology is required to understand preferences in this population.

Perceptions and recall of treatment for prostate cancer: A survey of two populations

“…This present study builds upon two previous studies [15] , [16] . The first study captured the perspectives and preferences of 22 prostate cancer patients regarding image-guidance related procedures (fiducial markers versus transperineal ultrasound) via semi-structured interviews [15] .…”

Impact of transperineal ultrasound on perineal skin dose in prostate radiation therapy

“…Though clinical staff can assess anatomical compression with measures such as the PICS distance or CPR, Pang et al (2017) concluded inter-observer variation with the Clarity system whilst minimal, appeared to be influenced by training and/or level of experience [22]. It is also expected that the avoidance of excessive compression will aide in continued patient comfort and tolerability [7,8].…”

“…Intrafraction monitoring prevents surrounding organs at risk (OAR) from receiving higher doses and maintains the treatment intent according to the medical prescription [6]. The TPUS and associated set up is reported to be well-tolerated by patients [7,8].…”

“…In typical male pelvis anatomy without ultrasound compression, the perineum area is usually not within a mid-high dose region with reported distances of 4.86 cm (1.38 cm SD; range 2. [5][6][7][8] between the anal verge and prostate apex in 100 patients, and a median value of 5 cm (range: 3-7.5) in 95 patients [9]. However, clinical observations and research have demonstrated that structures, such as the perineum and penile bulb, can be shifted into higher dose regions due to anatomical compression via pressure applied by the TPUS probe [10][11][12].…”

Radiation therapy for prostate cancer: What’s the best in 2021

“…As a clinical result, Kaneda et al 83 reported a significantly lower positioning error when performing image guidance of external beam radiotherapy by matching golden fiducials instead of bone matching in a retrospective analysis of a series of 38 patients presenting intermediate-or high-risk prostate cancer and received EBRT following LDR brachytherapy. Interestingly, Brown et al 84 analyzed patient's experiences and preferences of imageguidance procedures, exploring the different perceptions about the placement of fiducial markers versus the use of ultrasound for image guidance of radiotherapy. Forty questionnaires were administrated to patients, with the aim to deepen: invasiveness, pain, physical discomfort, and psychological discomfort; moreover, 22 interviews further investigated insights into their perspectives and preferences.…”