Accidental transcutaneous displacement of a fiducial marker during transperineal prostate biopsy: a case report and narrative review.

BACKGROUND

Fiducial markers are commonly used to guide precise radiotherapy in prostate cancer patients. While intraprostatic migration has been described, transcutaneous displacement during biopsy is exceedingly rare. We report the first known case of transcutaneous fiducial marker removal during transperineal prostate rebiopsy. CASE PRESENTATION: A 62-year-old man with high-risk prostate cancer underwent radiotherapy with gold fiducial markers in 2020. Following two biochemical recurrences, transperineal MRI/ultrasound fusion-guided biopsy was performed in 2024. Increased resistance was encountered during the final biopsy pass, and a gold marker was found embedded in the core sample and was inadvertently removed transcutaneously. The procedure was well tolerated, and no complications occurred.

CONCLUSIONS

This case illustrates that even long after implantation, fiducial markers may still become dislodged during prostate interventions. While the event was asymptomatic, it highlights the importance of procedural awareness and planning to prevent potential compromise of radiotherapy accuracy in future cases.