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SpaceOAR during external beam radiation therapy

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Posted 2/26/2018 11:16 PM (GMT -5)
Saw my radiation oncologist today. Previous discussions had indicated that brachytherapy would most likely be the recommended treatment. But after a recent MRI, that no longer seems an option so now its going to be EBRT (sorry about the typo in the original post) instead. Five brief visits per week for 8 weeks. UGH! She also decided that I should definitely have a SpaceOAR device installed between the prostate and rectum to minimize damage to the rectum because the tumor is located against the rectum. Anyone have experience of the SpaceOAR?

Conspiracy theories about doctors getting rich are not helpful.
Posted 2/26/2018 11:49 PM (GMT -5)
What is HBRT? Did you mean IMRT? If so, there is no justification for going through 40 treatments - with what we know now, no patient should have to undergo that. IMHO, SpaceOAR doesn't do much. But both procedures raise billings - you are a cash cow for your RO.

Here's my take on SpaceOAR:
/pcnrv.blogspot.com/2017/01/spaceoar-hydrogel-is-difference.html

The radiation therapies you should be focussed on are SBRT (5 external beam treatments), or the other kind of brachytherapy, HDR-BT. They won't make your doctors as rich.
Posted 2/27/2018 8:35 AM (GMT -5)
Rockman - I can't help with regard to SpaceOar, as my RO didn't/doesn't feel that the benefit (if any) is worth the cost and the experience of yet another "procedure." I guess this one depends upon whose study you read and accept.

On the radiation front, though, I'd advise you take TA seriously. The 40-fraction plan is becoming less and less popular, as they have found that hypo-fractionation (breaking the treatment into fewer doses) has equal, if not superior, disease control results for PCa. The current "limit" of reducing the number of fractions appears to be SBRT (CyberKnife is one brand of SBRT), in which there are only 5 treatments given over a much shorter total duration - usually 2 weeks, but sometimes even 1 week. I advise you to seek a referral to such a clinic, just to learn about it. You may find that you prefer your treatments over the shorter time span. Be careful, though, and don't ask your current EBRT RO about SBRT. If they do not offer SBRT, they are highly unlikely to be able to tell you the complete story on it, and may offer an artificially negative opinion (as they may feel that the treatment that they offer is superior to all others when, in fact, it is not).

If you really want to do the 40-days' routine, no problem. It has been in use for decades. It is just that there are newer treatment options that are just as good (if not better) and that are of much shorter duration.
Posted 2/27/2018 9:42 AM (GMT -5)
Rockman,
I recently went through SBRT treatment (at UTSW in Dallas Texas) and the SpaceOAR was used as part of their standard practice. I have had no SE in my rectum / lower intestine. Part of the reason that
UTSW uses the SpaceOAR as part of their standard is they use a higher dose of radiation (45 gY over 5 sessions) compared to more common most places using 36 - 40 gY over 5 sessions so their is more risk to the rectum area of getting too much radiation.
If you do wind up going with the SpaceOAR suggest you confirm the expense and understand whether insurance will pay for it. As you might expect their is a website about the SpaceOAR where you can also look over information.
Posted 2/27/2018 3:16 PM (GMT -5)
Once again, ad nauseum, it depends on your life circumstances and what is available to you. Not everyone can go anywhere they want at any time. SBRT requires only 5 actual sessions but fair amount of planning. If you have the time and circumstances that's the way to go. I had 44 sessions of IMRT..not hypofractionated..which, by the way, is not "if not better". My RO is not completely comfortable with it but does it if the patient requests it. He's on the staff at Roswell and they aren't buying into it just yet. SBRT was not available under my circumstances. If it was do or die, I might have done it..might have. Besides, if you can "endure" 30 fractions you can "endure" 44. smile
Posted 2/28/2018 6:10 PM (GMT -5)
Rockman,

I had SRT (IGRT/IMRT) several years ago. The first question I had with my RO was if he uses or recommends SpaceOAR or other rectal spacers. He told me that he doesn't see any benefit, it is a costly procedure with risks (infections), and with IGRT/IMRT I wouldn't need it.

Well, I can tell you I had zero side effects during or after the 39 radiation treatments (1.8 grays, total of 70.2 grays). I never had to change anything during my treatment; I continued to work 8 hours per day, and I never changed my diet, I continued to drink 10 to 12 cups of coffee a day with a glass of red wine in the evening. So in my case, I am glad I never used hydrogel spacers.
Posted 3/2/2018 7:28 AM (GMT -5)
Hello Rockman.....I went the IGRT route .....45 fractions ...81 Gys....no SpaceOAR.....no problems at all now a year or so out .....every situation is unique though.....good luck....David
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