Patient Information

Transrectal Ultrasound Guided Injection of Gold Seed Fiducial Markers

What is transrectal ultrasound guided injection of gold seed fiducial markers?

As preparation for your external beam radiotherapy, it is now recommended that three gold seeds are injected into the prostate to improve the accuracy of delivery of the treatment. The procedure is performed under ultrasound guidance. This can be done under sedation/general anaesthetic or local anaesthetic.

Ultrasound uses sound waves to produce images. It is completely safe and there is no radiation. The sound waves are transmitted by the ultrasound probe (transducer). The probe is gently passed into the rectum and the prostate is visualised using the ultrasound. Three gold seeds are then injected into the prostate under ultrasound control.

Please read this leaflet carefully as it provides important advice on preparation for the procedure. You should have received your gold seeds from Adelaide Radiotherapy.

**Please read carefully the attached sheet regarding Medical Instructions.**

Preparing for the procedure

We will provide you with instructions regarding all aspects of preparing for your operation.

  • Pre-operative blood and urine tests.
  • Details of admission to hospital.
  • Information regarding fasting and medications.

If performed under local anaesthetic you do need to fast beforehand. Two hours prior you will need to take the antibiotics and use the enema.

Antibiotics: You should take the 2 ciprofloxacin tablets we have given you 2 hours prior to admission. Please take these only with a sip of water as you will be fasting for the procedure.

Enema: You should use the enema 2 hours prior to your admission. Remove tip from enema. Insert into the rectum and squeeze content of enema. The enema should work within half an hour.

What to expect afterwards

You may experience some bleeding from the urethra after the procedure. This can last from 2 days to 2 weeks, but it usually settles within one week. You may also see blood in the semen which may last for several weeks, depending on how often you ejaculate. This is not dangerous. About 25% of men have some discomfort passing their urine afterwards but this usually settles quickly. There is a possibility of perineal or scrotal bruising that will resolve in 10-14 days.


There is a small risk (1%) of developing an infection in the blood stream – septicaemia. This can cause you to feel unwell with fevers and chills. If this happens you should contact us. You may need admission to hospital for treatment with antibiotics through a drip. In the unlikely event this happens overnight you will need to go to a hospital emergency department.


You should expect to see some bleeding as mentioned above. If the urine is red then you should drink extra fluid to help keep the urine light in colour. If the bleeding seems excessive, or you are passing clots in the urine, then you should contact us. You may need admission to hospital.

Urinary Tract Infection

If you have burning when you pass your urine that does not seem to be getting better after 2 days then you could have a urine infection. Please contact us to organise a urine test and assessment.

After discharge from hospital

We suggest you rest quietly for the remainder of the day. Please avoid heavy lifting or straining until the blood clears from the urine and bowels.


You should not drive for at least 24 hours after having sedation/ anaesthetic (or as instructed by your Urologist).

Patients who are travelling outside the metropolitan area are required to check when they are able to travel, and will be required to stay in the metropolitan area for 24 hours (or as instructed by your Urologist).

Emergency Contacts

In the event of an emergency, call our office within business hours and speak to our Practice Nurse.  If out of hours, please call our office to contact our On-Call Urologist, or present to your nearest Emergency Department.

Royal Darwin Hospital

Rocklands Drive, Tiwi NT 0810 8922 8888 24 Hours

**For patient’s outside the Metropolitan area, please present to your nearest hospital emergency department.

Follow up

After insertion of the Gold seeds, you will be looked after by the Adelaide Radiotherapy Centre. Once your treatments with Adelaide Radiotherapy Centre has been completed, a follow up   appointment with your Urologist will then be arranged.

If you have any concerns after your procedure, please contact our office and speak to one of the practice nurses.

The content provided within this document is intended as a guide only and does not apply to all patients. Additional information, including patient specific potential risks, must be obtained during consultation with your Urologist.