Any advice or shared experiences with SpaceOAR Hydrogel?

Bill,

Your situation is almost identical to my own. I am 70 and am currently about 1/3 of the way through radiation treatment, having started the hormone-blocking about three weeks before beginning radiation.

I had the SpaceOAR insert. My radiation oncologist explained it to me and suggested it as a helpful option that I should consider. I read about the insert using some solid sources on the Internet. To avoid peripheral damage to other organs, this just made sense. While not the most pleasant experience (but then, we aren't really in this situation expecting pleasant experiences), it was not significantly more complex than the original biopsy. If you look up the results of its use to date, I believe you will opt for the insert. Of course, in speaking with others at the clinic where I receive my radiation treatments, it is clear that everyone's comfort or discomfort level is different.

Best of luck.

I don’t believe a spacer is ever used for salvage radiation. The spacer goes between the prostate and the rectum, so without a prostate there is no place to put the spacer.

Yup….and even if they could devise a barrier external to the rectum, it would be counter- productive for salvage cases.

I did Spaceoar, I did not like the shape of it as it only came about 60% down the prostate. I had my urologist review ( Spaceoar recommended ) and a Hopkins trained RO walk through individual dosage to every part of my body. I still think about it but I was at a center of excellence. My point is to make sure and review your CT/MRI and ask questions, it needs to be in properly not just injected.

SpaceOAR after prostatectomy is very rarely done, but it apparently can be done to reduce radiation dose to the rectum. I think it’s because most believe SpaceOAR’s only use is to distance the rectum from the prostate being radiated, when it’s actual purpose is to distance the rectum from whatever is being radiated.
As these papers point out, SpaceOAR can be used in the salvage radiation setting to distance the rectum from the local cancer recurrence where the prostate was.
Here are papers from 2015 about this:
> https://pubmed.ncbi.nlm.nih.gov/25339311/

> https://abstracts.mirrorsmed.org/abstracts/feasibility-spacer-insertion-dose-escalated-post-prostatectomy-radiotherapy-pprt-and

Here is a paper from 2019 about this: https://medcraveonline.com/IJRRT/IJRRT-06-00224.pdf

That’s why the newer product (Barrigel) is sometimes preferred over SpaceOAR. Barrigel allows more control of where the gel is placed. Unlike with SpaceOAR, Barrigel can be sculpted in place to create a custom fit to one’s anatomy.

I had SpaceOAR injected prior to my 28 sessions of proton radiation (April-May 2021).
SpaceOAR increases the perirectal space - by just over 1cm (about 1/3”). It’s easy to deal with and worthwhile moving the rectum out of the radiation field. (I’ve heard that it reduces radiation to the rectum by ~70%.)
Studies show that SpaceOAR not only reduces rectal radiation dose, but also protects from late GI and GU toxicities, with urinary, bowel, and sexual quality-of-life improvement: https://pubmed.ncbi.nlm.nih.gov/34029607/
I used the newer SpaceOAR Vue product, which is a modification of the standard SpaceOAR Hydrogel, containing approximately 1% iodine bound to the hydrogel to be more visible under CT scan. (We did not use fiducial markers.)
I had no adverse side-effects from the SpaceOAR injection. Yes, there was some bleeding and pain at the injection site (which is to be expected). I’d recommend that you ask them to be generous with the lidocaine (or whatever it is called that they use to numb the areas), both where they penetrate the skin and all the way ahead of where they’re injecting the gel.

There's another newer spacer option out there called Bioprotect. I had it implanted as part of my brachytherapy procedure.
https://bioprotect.com/the-procedure/

Brian, Very interesting…in the most recent 2019 article it does stress that there must be “clear macroscopic evidence” of disease in order to know where to place the barrier (between IT and the rectum). My PET was clear.
Also, you can’t unwittingly displace unseen cancer cells posteriorly toward the rectum with the gel- thereby blocking the radiation attempting to hit it.
My RO went over this with me - not in the same detail, however - when I asked about it; and the last thing I wanted was rogue cells being protected by s barrier and getting away from the path of the beam.
Don’t get me wrong, I am still very concerned about possible future toxicities, but I was very strict in my adherence to dietary guidelines and they were checking for gas before every session so I just closed my eyes and hoped for the best.

My PC was also contained to the prostate. I had fiducials implanted and I was expecting to get SpaceOAR but they said no need. My 28 x IMRT certainly cause urinary issues (beginning a couple of weeks into treatment and on-going 5 months after) but it seems they were right as I had no rectal issues at all.

Incidentally, after IMRT was complete, the other thing they said I didn't need was Brachytherapy. It was a very good day when they told me that.

You've started ADT now, good luck. My journey with that has included all the worst side effects so please read up on them, recognize them, and be mentally prepared for them, if they occur. I have a so much better understanding of women now that some days I could cry about it. That was a not-far-from-the-truth, ADT joke.