I'm conflicted

@stew80
Did the doctor who gave you this information state whether they never have done the Space/Oar or just something recently?

I say this as my Mayo PCP said a lot of studies out there now to see if the procedure and stress of the procedure is worth it to patient in terms of does it reduce radiation damage to colon.

Are you having proton radiation or photon. There is a big difference between the two. Not in terms of successful treatments but that photon goes into body ful force, treats cancer area and exist through the body ad full force. Proton radiation enters body at low dose, treats cancer and margins at level of radiation programs and stops. It does not exit body.

So you can see the relationship with having Space/Oar and drinking water (moves the bladder away) has with radiation. I know that those at UFHPTI if could not do Space/Oar did the balloon before treatments.

Comment, no doctor should get defensive with question being asked. The patient asking questions should be encouraged not discouraged.

I'm having EBRT which I guess will be a linear accelerator (linac) sending high-energy X-rays or gamma-rays to the tumor. I'm required to have a full bladder and an empty colon.
You're right about my right to ask questions without a defensive response.
I'm wondering who got EBRT without the SpaceOAR and if they were happy with the result.

I got the 5-fraction SBRT, total 40 Grey, without the SpaceOAR.
(I believe that the spacer should be injected the same hour as the gold seeds fiducial markers are implanted, so I asked my care team if I would have it. I was told that they give it to patients who couldn't have the gold seeds implanted; as I had the markers I didn't need the spacer.)
I noticed some mucus and little blood on my bowel for a few days post-SBRT. I reported this to my radiation oncologist. Somebody in this forum indicated to me that the mucus was a sign that my rectum was healing, and with the blood veins still sensitive the bowel picks some blood . I trust/hope that our support group member is right. The bleeding stopped after a few days, not even a week.
I am now nine weeks post-radiation treatments and feeling great. I would still have liked the SpaceOAR, perhaps it would have prevented the bleeding.
I don't necessarily question my care team's saying that I didn't need it. My treatment in Canada is taxpayer-funded, so I get what is really medically necessary, not what I wanted.
(I think your U.S. private insurance will let you get SpaceOAR.)

I had EBRT a year ago. Prior to the start of any TX, I met with 2 different RO at Cleveland Clinic (CC). The first RO meeting I was told I needed the spacer prior to radiation. At that time, I decided to wait to start TX and went on active surveillance. Things changed and when I saw the second RO at CC, he told me they no longer use the spacer procedure. Things are changing quickly with PCa.

I had SpaceOAR Vue injected - it’s an enhanced version of the standard SpaceOAR Hydrogel - as additional insurance against rectal tissue injury.

Was it absolutely necessary? Of course not. But, that additional 1.3cm of “insurance” (see attached image) provided a 70% reduction of radiation to my rectum. (Minimizing potential side-effects of treatment was important to me.) My RO had never used SpaceOAR before, but my argument for using it was stronger than his argument for not using it; so, we did.

The value of rectal spacers has been demonstrated in clinical trials. There are no contraindications from the gel itself. (You can read additional information here: https://contentstaging.spaceoar.com/assets/LCN-80-3101-001-en-Rev-D_SpaceOAR-System-10mL-IFU-CAN.pdf)

At a recent PCRI conference, even though Dr. Rossi is talking about using SpaceOAR with proton radiation in his presentation, the rationale is similar when using IMRT: https://www.youtube.com/live/WTqPnSRYtW4?feature=share
—> Starting at 4:49:45: Proton & Hydrogel.

Like I said earlier, my RO had never treated using SpaceOAR before; he had always used endorectal balloons. But, I insisted and personally reached out to Boston Scientific (the manufacturer of SpaceOAR) myself to get my RO in touch with them. We even had to find a local urologist with experience injecting it. The time it took to get the product in and find an experienced urologist to inject it was only a matter of a few weeks. (So, I didn’t have to go elsewhere; I had the product brought to them.)

There were no hurt feelings here. My RO and I had a very good doctor-patient professional relationship. We discussed all aspects of treatment, and involved shared decision-making throughout.

Ultimately, you’re the one who will have to live with the treatment outcome (not them), so it’s your call.

Good luck!

@stew80

With either proton or any particular photon machine, if you don’t have the spaceoar and you have bleeding or some side effect, will you be kicking yourself if you do not have it?

I had it and used the MRIdian machine. I would do it again without a doubt. That extra spacing can reduce additional exposure and potential side effects.

One man's experience is just anecdotal, but I had SpaceOar before five sessions of SBRT and had, and have had, zero rectal issues and it's been a year.

Been over two years after Space oars- no problems here. You are correct.

It’s going on two years since treatment and I had SpaceOar and no issues with that or the anatomy that it was to protect. There have been a few stories on here in other forums and the effect of not having it and the issues and problems because of it. A non healing open sore/burn on my anus doesn’t sound like a lot of fun. Before treatment, during my consult with my oncologist, I asked him about it and he looked at me with surprise and told me he was going to bring it up but I did first. The procedure is not bad at all and I’m pleased. If you feel safer with it, get it. Better to be safe than sorry. Going past two years since, I am amazed by how treatment has changed. I’ve even just read of veterinary anti worming medication being used to treat cancer with very positive results. The holdback to its use is it’s not approved. And when I say positive results, I mean total elimination on cancer in the subject body and I mean end stage stuff. Good luck and stay strong.

About a year ago, in our first meeting, my RO recommended that I have the SpaceOAR gel injected before EBRT. He said that they use it with nearly every patient. He told me that given the location of my lesions, he thought I would benefit.

As @vircet described, I had the SpaceOAR injected during the same procedure in which the fiducial markers were embedded. The procedure was done under general anesthetic - no problems other than a little blood in my urine for a few days (I assume this was from inserting the markers, not the gel.) I could feel a little pressure in my rectum (like I needed to have a bowel movement) for a few days as my body adjusted to the gel pack- no big deal.

I wrapped up 28 sessions of EBRT 6 months ago - have had no rectal/bowel issues so far.