Any advice or shared experiences with SpaceOAR Hydrogel?

Brian, Very interesting…in the most recent 2019 article it does stress that there must be “clear macroscopic evidence” of disease in order to know where to place the barrier (between IT and the rectum). My PET was clear.
Also, you can’t unwittingly displace unseen cancer cells posteriorly toward the rectum with the gel- thereby blocking the radiation attempting to hit it.
My RO went over this with me - not in the same detail, however - when I asked about it; and the last thing I wanted was rogue cells being protected by s barrier and getting away from the path of the beam.
Don’t get me wrong, I am still very concerned about possible future toxicities, but I was very strict in my adherence to dietary guidelines and they were checking for gas before every session so I just closed my eyes and hoped for the best.

I had SpaceOAR injected prior to my 28 sessions of proton radiation (April-May 2021).
SpaceOAR increases the perirectal space - by just over 1cm (about 1/3”). It’s easy to deal with and worthwhile moving the rectum out of the radiation field. (I’ve heard that it reduces radiation to the rectum by ~70%.)
Studies show that SpaceOAR not only reduces rectal radiation dose, but also protects from late GI and GU toxicities, with urinary, bowel, and sexual quality-of-life improvement: https://pubmed.ncbi.nlm.nih.gov/34029607/
I used the newer SpaceOAR Vue product, which is a modification of the standard SpaceOAR Hydrogel, containing approximately 1% iodine bound to the hydrogel to be more visible under CT scan. (We did not use fiducial markers.)
I had no adverse side-effects from the SpaceOAR injection. Yes, there was some bleeding and pain at the injection site (which is to be expected). I’d recommend that you ask them to be generous with the lidocaine (or whatever it is called that they use to numb the areas), both where they penetrate the skin and all the way ahead of where they’re injecting the gel.

While you have a lot of Gleason scores, the only one that counts is the 4+3. Your Gleason score is a seven.

It is interesting how long they are putting you on ADT. NCCN guidelines show that you only need six months of ADT if you have a Gleason seven. 24 months is needed for a higher Gleason score. Your decipher score, however, is very high, Sounds like they are being real aggressive, Which may extend your life in the future, or may be overdoing it.

The SpaceOAR does make a lot Of sense. It does protect you with the radiation gets to be too wide spread while doing it. I can’t think of any reason why not to do it. Some radiation oncologist don’t like it, but yours does, which is a good thing.

In your case, doing 4 or 5 SBRT Sessions to the prostate could reduce the number of IMRT sessions by a lot.

Have you had a second opinion? The treatment you’re Planning on getting seems to be A little outdated. Have they explained why they are doing only doing IMRT.

I think it would make sense for you to go to a center of excellence and get a second opinion on what kind of treatment you should get.

The Gleason 4+3 in several cores plus cribriform architecture and the Decipher score translates to high risk. I would want aggressive treatment. 24 months of ADT is reasonable unless you have really severe side effects. Most people can deal with the side effects of Lupron. I believe IMRT is often recommended for higher risk patients and can have fewer side effects than SBRT. Both are painless, so I don't see any compelling reason to resist IMRT. (I have similar biopsy results and had 24 months of Lupron as four six-month doses plus IMRT with SpaceOAR. Perhaps lucky to have the standard side effects, but nothing that was all that hard to deal with).