SpaceOAR causing issues

Mike, Sorry, this is a thread on preparing for radiation treatment of an intact prostate already diagnosed with prostate cancer. Nothing to do with biopsies.

My biopsy was also negative from both sigmoidoscopies I had. Sorry your ulcer has not healed. My ulcer healed after 04 months. We both fall into the failed category for the SpaceAOR gel.

drj, I think Mike was suggesting the possibility that the infection might have come from a transrectal biopsy vs transperineal biopsy rather that the hydryogel/SpaceOar insertion. Might be somewhat clearer if imbimbo had mentioned the time spread between biopsy and treatment.

I had perineal. Two weeks after it was inserted I had the symptoms of an infection but the doctors did not diagnose it until a full month after the infection started. I never started radiation

Just for clarity in the comments: there are needle biopsies, and there are needle hydrogel placement. The real estate is usually quite different. I believe most prostate biopsies are transrectal. The biopsies are then used to make the diagnosis and inform potential treatments.
Once the decision is to treat by radiation, some people precede that radiation by a couple of weeks with hydrogel insertion to minimize radiation damage to the colon, etc. Hydrogel placement is with an injection by an ultrasound guided needle in the area between the scrotum and the anus. This area is also known as the perineum. Numbing of the area immediately before the insertion was done by three injections.
It may be possible to do perineal biopsies of the prostate, it's just that I'm not aware of any.

I had two biopsies : one to confirm cancer and the second was a biopsy of the ulcer in my rectum caused by the hydrogel insertion. The rectal biopsy was done during a colonoscopy and had nothing to do with the prostate biopsy

Thanks for that added information.

It's my own speculation, but here's something I wrote previously: "How do you do stick a needle there without damaging prostate, rectum, etc.? ". In other words, even when ultrasound guided, positioning a long sharp needle in that small space has to have some risk associated with it, like nicking something you want to avoid.

I would note that hydrogel itself worked well for me. I would recommend it. It's the placement of it that's tricky. So is would suggest that the "prostatectomy rule" applies: don't go with a surgeon who only does one radical prostatectomy a month. Same with hydrogel placement.

Rectum insertion of spaceoar is what I had. It gives 1/2 inch extra spacing between rectum and Prostate. I had my radiation and no rectum issues. Finished radiation on Valentine’s Day.

The percentage is quoted on the spaceoar site in terms of bad issues and they are very low. If I had to make that decision again, I would do it again.Orlando health cancer had a spaceoar technician in the operating room and they put me out for it.

By the way, spaceoar customer support will spend time with you on the phone if you want them to answer questions. It was helpful to me.

@drj I'm proof that perineal biopsy is a thing. After having 3 transrectal biopsies that came back negative for cancer all the time having my PSA rising, Mayo Rochester did a perineal biopsy and found the cancer 4 - 3 Gleason score. had Proton SBRT 5 times over 10 days in September of 2020.

Good to know. Thanks for passing this on.

This is a highly valuable site for helping the newly diagnosed and those facing treatment decisions, particularly with the sharing of direct patient experiences, and this was informative.

It might be helpful to provide more information on the transrectal biopsies. I assume they were 12 core needle biopsies? The 12 core biopsies really improved cancer detection, but they are far from perfect. Your experience will be very informative. Frankly, I'm somewhat shocked. In addition, I was unaware of the possibility of a perineal biopsy, so thanks.

In my case, they had found the main lesion by an MRI technic*. When it came to doing the biopsies, they had a good idea where to go, and they used that image, and real time ultrasound to guide the needle to that spot and others. I was able to watch the biopsies being done on a screen, with commentary by the doc doing the biopsies.

* I don't know if the MRI was something different from routine, but I do know that prostate MRI is getting better, and they are studying to see if it can become diagnostic almost like a biopsy.