Any advice or shared experiences with SpaceOAR Hydrogel?

While you have a lot of Gleason scores, the only one that counts is the 4+3. Your Gleason score is a seven.

It is interesting how long they are putting you on ADT. NCCN guidelines show that you only need six months of ADT if you have a Gleason seven. 24 months is needed for a higher Gleason score. Your decipher score, however, is very high, Sounds like they are being real aggressive, Which may extend your life in the future, or may be overdoing it.

The SpaceOAR does make a lot Of sense. It does protect you with the radiation gets to be too wide spread while doing it. I can’t think of any reason why not to do it. Some radiation oncologist don’t like it, but yours does, which is a good thing.

In your case, doing 4 or 5 SBRT Sessions to the prostate could reduce the number of IMRT sessions by a lot.

Have you had a second opinion? The treatment you’re Planning on getting seems to be A little outdated. Have they explained why they are doing only doing IMRT.

I think it would make sense for you to go to a center of excellence and get a second opinion on what kind of treatment you should get.

I had spaceoar in 2023 before my 5 sessions of targeted radiation. It was a week or two before I was treated. I felt a little full in that area after it was done but other than that, no issue. I am in Orlando and they had a spaceoar representative in the operating room to make sure the process went smoothly. You may want to call Boston Scientific and ask them about this as some radiation oncologists have more experience than others and they use to rate the experience level of doctors on their web site. I was glad I did it.

In terms of radiation, 2 mm margins for the Mridian with built in mri is significantly different than 3-5 mm for other radiation machines, which use 3-5 mm for non-mri built in radiation machines, in terms of side effects and toxicity. Here is an article on the Mirage randomized trial. Its worth a read:
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

Take this as anecdotal, but I had the SpaceOAR gel and SBRT and had zero rectal issues during or after my radiation treatment. My treatment ended in June 2024 and everything is still OK in that department.

It can be a bit uncomfortable (not painful) until you get used to it, and it does linger a bit longer than the six months they say. Also, the doctor who implanted it told me no bike riding for three months so it doesn't get compressed too much or move, though some guys in my support groups said their doctors placed no restrictions on them at all.

@build511
I had the Space/Oar done at same time as gold markers done. It was done transpernial with some medications to cut down on anxiety. I was offered laughing gas and used it at first mainly out of anxiety. When I got the numbing of site over I quit using it as the procedure was discomfortably (legs in stirrups) but was not painful.

The Space/Oar will help move the rectum away from prostate. This helps reduce radiation damage to rectum when prostate and margins are being radiated deemed needed by your R/O. I did not have any discomfort from Spave/Oar other than feeling it was there.

I have seen some posters say they were not told to stop bike riding. My R/O was adamant not to bike ride prior to simulartion, prior to procedure start, during procedure, and for comple of weeks after. Reason, the bike seat can push up where the Space/Oar is and cause it to move. This will affect your simulation readings and adjustments after and during treatments.

Also follow dietary instructions. If you don't get them ask for them to address gas in rectum. Gas in rectum can put pressure up against prostate and actually move it. This will change the measurements prior to and during treatments.

This suggestion comes from experience of one day prior to treatment eating protein supplment that contain soy. I did not pick up on the Soy (bean). During that session my techs came in and said you have gas and causing the prostate to move around. It took a lot more readings to get started, and then additional ones during treatments to ensure prostate not moving.

I then went over my diet the prior day and they said do not take the soy protein. I had been told not to eat beans and other foods identified in a handout given to me by my R/O and was following that but missed the soy in the protein supplement.

I am a bit confused - or ignorant…or both! But why are fiducials being placed if you are having IMRT? They are usually used in an SBRT 5 session setting, not for 25 sessions. They are used to specifically target the gland only.
Also, the gel spacer similarly is used with fewer high dose treatments, not weeks long IMRT. Longer treatment times 25-39 sessions usually are designed to give radiation around the rectum as well, so the spacer will prevent that area from being treated.
Please don’t get upset by my questioning, but to me it seems like your RO is mixing apples and oranges. And Just because I have not seen this treatment protocol, doesn’t mean anything. It is just my layman’s opinion.
It almost seems like your RO “might’
Be suspicious that your cancer is outside the gland already (high decipher)and wants to insure that he treats it, but Gel spacer and gold markers wouldn’t be used in that case.
Maybe ask some him some Questions?

I had the SpaceOAR inserted prior to my 39 IMRT (VMAT) sessions. It was done in the urology clinic using local anesthesia. I was prescribed an Ativan tablet before the procedure to reduce anxiety. There was a Boston Scientific rep in the room to observe. Other than some mild discomfort during the procedure, it was uneventful and I was on my way home after about 30 minutes.

It has been about 19 months since my radiation treatment ended and I have had only one day when there was blood with my bowel movement. On the other hand, I have a friend who underwent prostate radiation last summer and he did not have a spacer used. Since then, he has had one emergency procedure to deal with rectal bleeding and is scheduled for another procedure to deal with ongoing bleeding.

I feel great, my PSA numbers continue to drop, and the RO has declared that my cancer is in remission. Hoping for the same for you.

I had fiducials inserted for my 39 IMRT (VMAT) sessions. Prior to each session, a scan of my prostate was done and the fiducials helped determine the relative position of my prostate so that the VMAT beams could be sculpted properly.

I completed 28 sessions of photon EBRT with True Beam CAT-scan guided technology at the end of December. I had fiducial markers implanted as well as a SpaceOAR gel pack. (Bracketed by 6 months of ADT using Orgovyx).

As @scottbeammeup suggests, I had a little discomfort/pressure, but only for a few days after the SpaceOAR was injected - basically felt like I needed to have a bowel movement when I didn't.

I had urinary urgency/frequency side effects starting about mid-way through the radiation treatments - these persisted through about four weeks after the end of my treatments. My only bowel-related side effect was that I started having a couple of bowel movements each day (prior to treatment, it was once a day, in the morning). But after several weeks from the end of treatments, that too has passed (so to speak).

Best of luck to you @billd511 !

SpaceOar made my poop smaller diameter. This resolved gradually over 3-4 months or so.

This puts you at greater risk for serious constipation -- especially likely if you take pain meds.

So, adjust your diet as needed. But this is more difficult because a low-fiber diet is strongly recommended to prevent gas.

Bottom Line: To reduce the risk of radiation affecting the rectum, SpaceOar (or comparable spacer) is definitely highly recommended.

Ahhh, now I see….You learn something new on this forum every day. I had only seen fiducials used in Cyberknife. My sessions were salvage - NO PROSTATE. So they did a cone beam Xray every day (built into the TruBeam) before treatment to check for rectal gas, bladder fullness, and proper positioning.
I had no gel spacer since there could be cells near the rectum and they had to hit those too. My PET was also “clear”, but we all know what that means.
Glad you are doing well.
Phil