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I'm conflicted

Posted by stew80 @stew80, Jun 28 4:57pm

Guys - I've addressed this before but as I draw closer to mapping and ultimately the EBRT (20 fractions) starting soon after, I read that many men have the SpaceOAR injection of hydrogel first as a preventive measure for damage to the bowel/rectum. I asked my RO about it and he said they don't do it here (which is deemed a center if excellence for prostate cancer). It would only be recommended if the patient had an existing bowel disease like colitis. He got defensive about it. The nearest prostate center to get the injection is 150 miles away. I'm not sure whether to request it to be prescribed or pay myself. I am conflicted and unsure about the risk/reward. It seems like a no-brainer but I don't know.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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heavyphil | @heavyphil | Jun 30 3:50pm
In reply to @ededed "I had 42 sessions of IMRT, Nine months after treatment I developed chronic radiation proctitis. It..." + (show)
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I had 42 sessions of IMRT, Nine months after treatment I developed chronic radiation proctitis. It has changed my diet and for a period of 1 1/2 years it limited my daily activity. My urologist told me I could not get the barrier gel because of the location of a metastasis very near the outside of my colon. I would have liked to have skipped the whole radiation proctitis disease and now my gastroenterologist says I'm at risk for colo-rectal cancer.

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Same here, Ed. I did not have metastasis per se, but RO said that cells ‘could’ be in the area and he wanted to treat them as well.
He assured me that he would be able to ‘shape’ the beam to go around the rectum ( don’t ask me how you can do that with photons) so I went ahead with his recommendation.
Every one of my 25 sessions had a cone beam Xray to verify the position of the rectum and verify that it was in the same position as for the simulation visit. Only time will tell!
Phil

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kenk1962 | @kenk1962 | Jun 30 5:57pm
In reply to @vircet "@kenk1962 : 1. We started differently: You had SpaceOAR, I didn't. 2. Two weeks after SBRT,..." + (show)
Profile picture for vircet @vircet

@kenk1962 :
1. We started differently: You had SpaceOAR, I didn't.
2. Two weeks after SBRT, you have bleeding & rectal pain; a few days after SBRT (late April 2025) I had mucus and some traces of blood on my bowel but no rectal pain.
3. You were thinking how much worse it could have been short-term without the spacer; I was thinking if I wouldn't have had any bleeding at all if I had it.
4. I share your concern about what the long-term side effect(s) will be: (a) In your case, SBRT with spacer; (b) In my case, SBRT no spacer.
5. May I suggest we both update this support group of ours, if either or both of us developed more side effects (in the medium or long term) that may help "newcomers to the club" -- who may at that time be on the crossroads whether to have the spacer or not.
I wish you a fast recovery from your immediate side effect(s).
Best,
Vir

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Yes Vir - I'll certainly update the group on my eventually outcome.

We're all reluctant members this prostate cancer fraternity and need to help each other whenever possible.

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jc76 | @jc76 | Jul 1 6:02am
In reply to @brianjarvis "Much went into my decision to still use SpaceOAR Vue even though I was receiving proton..." + (show)
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Much went into my decision to still use SpaceOAR Vue even though I was receiving proton radiation with its Bragg-Peak characteristics. It was additional insurance just in case…..

As for not riding a bike after injecting SpaceOAR, recommendations vary. Some say to avoid strenuous/heavy exercise/lifting for a couple of days, and running/jogging for a couple of weeks, and bicycle/motorcycle riding for a few weeks. (The guidance for Barrigel might be different, since it remains sculptable for a while after injection. I’m not sure what the rules are for the newer product BioProtect.)

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The discussion of Space/Oar type of injections to help move colon away from radiation being done to prostate is good.

When I mentioned being told not to ride a bike after Space/Oar was intented not only to let the Space/Oar hardend but to also not have any activity that could possibly move it.

After it is put in it seems irrelevant as I was told for the entire proton radiation treatments to not ride a bike. The reason is just like before PSA tests you don't want to further irritate a prostate from bike riding.

I did mention that my Mayo PCP was monitoring research on the benefit of Space/Oar for those undergoing radiation treatmtents versus those who did not have it. This was to see if any significant benefit from it versus the procedure being done and any possible issues.

The same research was also looking at drinking water prior to radiation to move bladder away. Again from those who did drink water versus those who did not was there any significant benefit to the process.

I am not sure when the research will be concluded but have an upcoming appointment with my PCP and will asked.

For me there was no hesitation on getting the Space/Oar nor drinking the water prior to radiation (UFHPTI is where I was treated). I wanted to do anything I could to possilbe limit the radiation damage to other tissues and organs outside my prostate and margins that had been set up. It was the main reason I chose not to have photon radiation at Mayo Jacksonville (only offered photon not proton) and had it done at UFHPTI which is center world reknown proton radiation treatments for cancers since 2006.

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rotate | @rotate | Jul 1 10:33am

I recently had proton beam therapy for PC at Mayo.

During the planning process, SpaceOAR was assumed. It wasn't a choice (if I had objected I'm sure it would have been).

My only issue was that it caused a significant increase in the feeling of rectal fullness - but that's fading and should go away. On the CT imagery, it shows up very clearly - and clearly would reduce the spillover radiation (even proton therapy with its Bragg Peak effect is not perfect - you do get significant radiation outside the target - in my case, an intact prostate).

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