Bladder and Bowel Preparation for prostate radiation

@vircet - My treatments were delivered with a Varian TrueBeam linear accelerator machine.

My understanding is that there are some treatment centers that ask patients to administer an enema prior to each treatment.

When I was given my prep instructions prior to the start of my treatments, I asked if I should administer an enema each time. I was told "No, that's not necessary." But I wasn't told that it was something I shouldn't do - so I did it on a few occasions when it seemed like my bowels were not completely empty.

Had my first prostate cancer proton treatment today. My gut was in bad shape, which didn't bother them. I guess their main focus is on the bladder.

@rotate Did you have SpaceOAR? I asked my oncologist about it, but I was told that I don't need it. My 4th SBRT treatment tomorrow.

Yes, I have it. Are you getting proton or X-ray therapy? I am getting proton beam.

@rotate My treatment is SBRT + ADT (Orgovyx, on my 22nd day today). My 5th SBRT fraction will be on Monday.

I asked the Grok AI about this and it replied with:

Someone getting SBRT for prostate cancer might not have a SpaceOAR implanted due to:
Anatomical or Medical Contraindications: Conditions like active infections, inflammatory bowel disease, or anatomical issues (e.g., rectal wall abnormalities) may make SpaceOAR placement risky or infeasible.

Low Risk of Rectal Toxicity: If the radiation plan (e.g., highly precise SBRT with small margins) or patient anatomy already minimizes rectal dose, SpaceOAR may not provide significant additional benefit.

Physician or Patient Preference: Some doctors may not recommend it based on their experience, or patients may decline due to concerns about the procedure, cost, or potential side effects.

Cost or Access: SpaceOAR may not be covered by insurance, or the treatment center may not offer it.

Clinical Judgment: For certain patients (e.g., those with low-risk disease or specific treatment plans), the benefits of SpaceOAR may not outweigh the risks or inconvenience.

Explain SpaceOAR benefits

Compare SBRT to IMRT

They are concerned with stool in the rectum not the bowels in general. I used psyllium to help me get regular and gas Ex. They didn't want use doing an enema and they wouldn't provide it so did the conceal carry of one if needed. Partial insertion into the rectum and had to use it once. Can't imagine doing a full blow 5 days a week. My salvage was EBRT 25 sessions and developed both bowel and bladder urgency which sucked the life out of me. Told my urologist yesterday that I would probably choose recreational drugs next time.

I met with my RO once per week during 25 sessions. Every week he’d say the same thing: “You have so much stool! But it’s not in the rectum so it’s OK…”
In protest, I would counter that I had a good BM every day…but he’d shake his head and laugh. Finally, after about the 5th time I said “So Doc, are you saying that I’m full of sh**? Because my wife already knows that!” 😆

Haha Great lesson on how to say it without saying it!

@chippydoo - You're quite right - all of the instructions I received from my treatment team had to do with what they didn't want to find in my rectum. I just figured the best way to make sure my rectum was empty was to have a full bowel movement before the treatment (my treatments were scheduled for 8:00 am, which worked well with my usual "constitutional" schedule). Across 28 treatment days, I used an enema three times (no need for concealed carry - my prep was done at home). I had one day when I had to get up from the table because they said I had some gas in my rectum. That cleared as I was walking down the hall to the restroom, so I was only delayed about 5 minutes.