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Fiducial Marker and Rectal Spacer

User
Posted 11 Sep 2025 at 04:55

Apologies if this topic has been covered before. I am resident in UK but mostly abroad. Because of my situation I have been attending a private hospital as a self-pay patient because ‘prostate’ is an exclusion on my insurance.


I have taken a PSA test six-monthly for the past ten years. The steady rise led to and MRI and then a biopsy in 2023. I was assessed as Gleason 3+3, Gp 1 and put on Active Surveillance.


A rise in PSA led to another MRI in May 2025, when I was assessed as R-PI-RADS 4, L-PI-RADS 2+ new R-PI-RADS 4. Gleason 3+4


Radiotherapy was recommended. I have taken two hormone shots, and am ready to start the process. I was then told that I must undergo a procedure in preparation – the insertion of a Fiducial Marker and Rectal Spacer as standard at the hospital. Unfortunately, this latter procedure will double the overall cost. When I look online, I can’t see anything definitive about the necessity of the procedure. I can see that it is not always offered in the UK.


So, my question is about how necessary it is and has anyone experience of it and can offer advice?

User
Posted 13 Sep 2025 at 00:13

NHS doesn't offer rectal spacer as standard. With the accuracy of targeting and masking in modern LINACs, the chances of serious rectal issues is now low, and it's not considered worthwhile to offer it to everyone on the off-chance. Many radiotherapy units do buy a small number of rectal spacers for use in patients where rectal bleeding would be a serious issue, such as those on life-long blood thinners, IBS/Crohns, some diabetic patients, etc. It is often still offered privately, but the private price has rocketed in recent years for no good reason.

If you're having your RT in another country, I don't know how recent/modern the LINACs will be.


Fiducial Markers are part of the image guidance used by modern LINACs to accurately target the prostate, but this isn't the only way to do it. The image guided LINACs have a diagnostic X-ray head on the gantry too. This is used during aligning to take two X-rays at right angles to each other for aligning your prostate in the centre of the treatment beam, using the Fiducial Markers. Another way they can do it is to use the X-ray head to do a cone beam CT scan to make a 3D image of your prostate, bladder, and rectum, and this doesn't require Fiducial Markers. The cone beam CT scan is a higher X-ray dose (but less than a regular CT scan) and it takes longer to do, so they get fewer patients through the LINAC per hour, but it avoids the Fiducial Markers. Another way to do the image guiding is to use an MR-LINAC which is a combined MRI scanner and LINAC, but there aren't many of these in existence.


Much of this is going to depend what equipment is available where you are being treated.

User
Posted 13 Sep 2025 at 01:47

Thank you, Andy62 for the quick reply.


I don't know about the equipment in use but I will ask today. The hospital is one of the top three in Bangkok, so my guess is that every department has up to date equipment. People fly in from all over for treatment due to the hospital's reputation. It may also be that the bulk of their work is covered by insurance therefore they apply all procedures as standard to boost profit. I have no evidence for that, but I suspect it to be the case. I am also asking today for a referral to the top local cancer hospital where I will seek a second opinion.


Besides the outlay so far for MRIs, scans, biopsy, hormone jabs etc, which has come to 4,000 pounds, the simulation and RT adds 7,500 BUT the marker-spacer procedure adds another 8,500 hence my dilemma. 


I am also NHS registered and could return home for treatment. Can anyone comment on the likelihood (or not) of a long wait-list? My local area is Shropshire, with hospitals at Telford and Wolverhampton. 

User
Posted 13 Sep 2025 at 06:32

Being NHS registered or a UK citizen is not enough to get treatment on the NHS. You have to be what's termed "ordinarily resident" in the UK. If you've been abroad for a while, it's really complicated to know if you are still classed as "ordinarily resident" in the UK. If you went abroad to work, that's less likely (except for the EU and a couple of extra countries), whereas going abroad as a student studying may be allowed for 3 years before you lose your "ordinarily resident" status.

User
Posted 13 Sep 2025 at 06:42

Thanks, Andy62. I have a full and unbroken record of national insurance contributions. I am also resident for tax purposes and pay UK tax on income derived in the UK. I will investigate the issue of 'qualification' further.

Edited by member 13 Sep 2025 at 06:48  | Reason: Not specified

User
Posted 14 Sep 2025 at 00:44

Originally Posted by: Online Community Member
BUT the marker-spacer procedure adds another 8,500 hence my dilemma.


Are you able to separate out the fiducial markers from the spacer? I don't know the cost of the markers alone, but it's a relatively quick process with no anaesthetic and very minor discomfort. I would guess that inserting the spacer costs a fair bit more.


Being treated for a locally advanced G9 with RT, I had the fiducial markers but no spacer.


Unless you've been given a very good reason for having the spacer it might be overkill.


Jules


 

User
Posted 14 Sep 2025 at 03:28
You don't say whether the HT you have had is the 4 or 12 week duration variety. In the UK it is mostly the case that RT is not started until a patient has been on HT for 6 months. This is continued during RT and for one to three years after RT, depending on the individual patient and Oncologist. I suggest you get referred to a well-regarded hospital where you could attend in the UK. RT is normally given in 20 sessions (called Fractions) but a small number of hospitals are now offering to do this in only 5 Fractions, which I assume you would prefer. So this is something else you need to investigate.
Barry
 
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