Recent Proton Experience?

@gently
@gently, your original and second post was and is correct.

The balloons were being used before Space/Oar was available. And it is still being done today as you posted.

Many patients for medical reason cannot have the Space/Oar done. Or they chose not to have it done. This is not a personal opinion. I asked my UFHPTI R/O about it after I saw the balloon technique being set up after me and he said the above to me. So it comes from a UFHPTI medical professional R/O.

I know when I finished my treatments at UFHPTI the next patient (who must have been same individual after me) the techs were setting up the balloon insert. It did not look bad at all but takes longer for set you up for your treatments.

Brian… very interesting history, I hadn’t heard that! When I was treated in 2019, one of the nurses heard that I had the spaceOAR, balloons, 43 treatments, and Lupron (45mg, 6mos) she commented “oh, you’re getting the gold treatment!”. I don’t know if she was referring to a Cadillac or gilding 😉, but I was glad I took the conservative route as I would prefer not to do this again! Thanks again for your comments and best wishes.

...is the proton technique on third party pay? Is longer lasting Space Oar [Vue] now the preferred method along with fluid filling of bladder before each session?

I just finish proton RT in May and because of the location of my tumor a gel spacer could not be used, so I had the balloon. Although certainly not terrible, it was the most uncomfortable part of the whole treatment. I was talking to the technicians one day and asked about balloons and they said probably 50% of their patients used them. I was surprised as I thought gels were more common now.

The balloon actually makes no sense to me: it inflates the diameter of the rectum, swelling the walls outward and closer to the beams.
So maybe the inner epithelium might get spared - depending on the direction of the beam, but I would think the outer tissue would be more vulnerable. The Gel Spacer is at least between the gland and the rectum - that kind of barrier makes sense.
Yes, proton advocates like to say that their technology is more precise, but there are plenty of SE’s reported in the literature ( though possibly less).

Medicare paid for my proton radiation treatments in 2021.

SpaceOAR Vue is a modification of the original SpaceOAR Hydrogel; it contains approximately 1% iodine bound to the hydrogel to be more visible under CT scan.

Studies show that SpaceOAR not only reduces rectal radiation dose, but also from late GI and GU toxicities, and provides urinary, bowel, and sexual quality-of-life improvement: https://pubmed.ncbi.nlm.nih.gov/34029607/

These days, if there’s concern “… of the location of the tumor” such that “a gel spacer could not be used…”, the goto is BioProtect. (FDA-approved in 2023.)

As this paper states, “…if you're worried about microscopic extracapsular extension being displaced through the liquid of the spacer,…..the likelihood of spreading extracapsular cells is virtually nil.”
> https://www.urotoday.com/video-lectures/lugpa-2024/video/3006-symmetry-visibility-and-control-the-advantages-of-the-bioprotect-balloon-in-prostate-cancer-treatment-edward-soffen.html

The advantage of SpaceOAR (and Barrigel) over the endorectal balloons is that the balloon protects most of the rectum from the radiation.

However, with balloons the anterior portion of the rectum is still fully within the field of radiation. By injecting the rectal spacer gel into the perirectal space, an additional 1.0-1.3cm of space is added between the entire rectum and the radiation.

The endorectal balloon made sense in its day, (“You go to war with the army you have, not the army you wish you had.”) It was the best they had 10+ years ago.

With FDA-approval of SpaceOAR in 2015 (and Barrigel in 2022, and BioProtect in 2023), you’d think that they all would’ve migrated to one of the other spacers by now.

But, even with prostate biopsies, some centers are still doing transrectal biopsies, even though transperineal biopsies are clearly superior.

It takes years to get a good idea into medicine; it takes twice as long to get an old idea out of medicine……

Well, it’s done now but I guess my RO isn’t up on the research. And that was the problem, a small ECE, although I don’t know if it was microscopic. But I think it was also the actual location of the tumor also.