1. < Prostate Cancer

SpaceOAR causing issues

Posted by imbimbo @imbimbo, Feb 16, 2023

I just spoke with my urologist today and he indicated that the hospital affiliated with his practice is no longer using SpaceOAR. Doctors in various parts of the country have seen complications. I attempted proton therapy last summer at Sibley Hospital and had the spaceOAR inserted. I for whatever reason got a horrible infection two weeks after it was inserted. I presumed it was a bad insertion by the doctor who was affiliated with Sibley (not my urologist here in Pittsburgh). So my advice to others who are not aware of this development, discuss this information with your doctor. My urologist as recently as December, 2022 was a proponent of spaceOAR and now he will not do it.

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

bens1 | @bens1 | Feb 21, 2023
In reply to @drj "Just for clarity in the comments: there are needle biopsies, and there are needle hydrogel placement...." + (show)
@drj

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.

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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.

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dandl48 Dave | @dandl48 | Feb 21, 2023
In reply to @drj "Just for clarity in the comments: there are needle biopsies, and there are needle hydrogel placement...." + (show)
@drj

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.

Jump to this post

@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.

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1 reply
drj | @drj | Feb 21, 2023
In reply to @dandl48 "@drj I'm proof that perineal biopsy is a thing. After having 3 transrectal biopsies that came..." + (show)
@dandl48

@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.

Jump to this post

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.

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1 reply
dandl48 Dave | @dandl48 | Feb 21, 2023
In reply to @drj "Good to know. Thanks for passing this on. This is a highly valuable site for helping..." + (show)
@drj

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.

Jump to this post

I went to Mayo's portal to refresh my memory on the number of core needle biopsies and surprise, it was 13. An odd number, whoever was counting messed up, LOL. Also, here is the link to Mayo re transperineal Biopsy. https://www.mayoclinic.org/medical-professionals/urology/news/ultrasound-guided-transperineal-prostate-biopsy/mac-20473283

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drj | @drj | Feb 21, 2023

To repeat the obvious: this site is a great place to learn by sharing our personal journeys. I'll check this out. Thanks.

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vircet | @vircet | 1 day ago
In reply to @ssaftler "I asked about Space OAR with my RO for my upcoming treatments, after hearing about it..." + (show)
@ssaftler

I asked about Space OAR with my RO for my upcoming treatments, after hearing about it from a relative who recently underwent radiation therapy for his PC problem and used it. I was told that my provider (Kaiser in Northern CA) does not use Space OAR any longer because of the relatively high rate of problems with it. Reading the comments here, I can see that they have a valid argument and I'll probably be better off without it. Even though it may increase the risk of other problems may be increased without it.

Guess I'll know more in a few weeks, when my external treatment starts. Having brachytherapy on Tuesday to start the process before the external photon radiation starts.

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@ssaftler How are you now more than two years after radiation? I also asked my RO about SpaceOAR before my SBRT April 9-21, 2025 and I was told I that I didn't need it. I was feeling I haven't advocated enough for myself, so I did some reading today and found your post. I don't feel bad now for not insisting on SpaceOAR, knowing that Kaiser doesn't use it same as my cancer center.

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1 reply
ssaftler | @ssaftler | 17 hours ago
In reply to @vircet "@ssaftler How are you now more than two years after radiation? I also asked my RO..." + (show)
@vircet

@ssaftler How are you now more than two years after radiation? I also asked my RO about SpaceOAR before my SBRT April 9-21, 2025 and I was told I that I didn't need it. I was feeling I haven't advocated enough for myself, so I did some reading today and found your post. I don't feel bad now for not insisting on SpaceOAR, knowing that Kaiser doesn't use it same as my cancer center.

Jump to this post

Well, I had my two-year PSA test about 4 weeks ago, and I'm happy to report that it is behaving itself, as I am still in the undetectable range (< 0.02). After about a year, all of the minor side effects have gone away. I was remarking to my wife some time ago that I actually have trouble remembering all of the tumult and anxiety I went through at the time. The human memory works in mysterious ways!

My journey still goes on, and I'm having a chance to pay it forward first hand at the Cancer Center where I was treated in 2023. A tumor in my head that was operated on in 2021 is beginning to grow a little, so my Neurosurgeon, who follows my annual MRIs, suggested that I do a 30-session radiation treatment on the spot to shrink it down, hopefully on a permanent basis (hey, I'm 70. 10-15 years is "permanent" in my book!).

Anyhow, I'm now back to the same location for this round of radiation as I was 2 years ago, with 24 of the 30 sessions now behind me. I've gotten to meet and talk with some other patients waiting for their treatment, mostly for Prostate Cancer. I'm always happy to put myself forward as someone who went through what they are now facing, stressing the positive recovery that I've had. Even more so, I have shown little or no side effects of this round of treatment, even though the location of the beam is in a much more precarious location this time. Maybe it's genetics, or a very positive attitude towards the Prostate and now Brain "problems" as eminently "fixable" with little upheaval to my life.

I guess you are now past the SBRT sessions and are getting back to a normal life. It's not exactly like it was before all this started, but close enough to what a guy moving through his late 60s would have expected.

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