How Important Is Having A Full Bladder During Radiation Treatment?

@ambika
Yes, the barrier gel is really important if you are having radiation. The thing is, there are more things to consider besides the barrier.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Because he has a Gleason nine have you been told he should get on ADT? Are they planning on putting him on it soon?. That really is an important thing to add with a Gleason nine. That can prevent reoccurrence and they usually want to do it for 18 to 24 months. It is also possible to use estrogen, With estradiol patches, Instead of ADT. It has been proven to be just as effective.

Here is a video about using estradiol instead of ADT. It cost a fraction of the money which is a reason doctors don’t recognize it. There was a patch clinical trial done in England that Showed it was just as effective as ADT, but had many if you were side effects.
https://ancan.org/

@ambika FYI - The amount of water recommended is highly variable. In my case, I apparently tend to absorb water rapidly, reducing the amount getting to the bladder. As a result, I am required to drink 32oz of water prior to treatment (luckily, I am allowed to include my morning coffee in that total). In re the spacer, I am undergoing proton beam therapy, and the protocol empoyed is a combination of features of BioProtect and SpaceOAR. BioProtect employs a balloon inserted rectally, which allows flexibility in adjusting the location of the spacer. After positioning, the balloon is filled with a biodegradable gel. Both the gel and the balloon are biodegradable. SpaceOAR injects the gel directly, and once injected, its location cannot be adjusted. In my treatment, a biodegradable gel is directly injected before the start of treatment. Then, each day (5 days/week) after positioning on the table, a balloon is inserted, positioned and inflated, providing additional space, before the treatment starts. The balloon is removed after treatment.

@jeffmarc His PSMA PEt/CT was done on February 27th 2026 at Stanford, CA but we haven’t seen the report. However one doctor who does HIFU and TULSA PRO at Stanford with whom we have a video meeting emailed saying that my husband Mark is not a candidate for that because he has a very high grade cancer but it is contained in the prostate. We have an appointment with Radiation Oncologist, Dr. Mark Buyyounouski at Stanford on 03/20 and with another radiation oncologist at UCSF, Dr. Mach Roach on 03/27 and I am sure they both will recommend hormone therapy. However my husband also had a full knee replacement surgery at Stanford on 01/27/2026 and hormone therapy will make his knee recovery difficult.
I have also contacted Dr. Stephen Scionti, a HIFU, TULSA PRO and Cryotherapy specialist who has dedicated 25 years to master only these treatments and is perhaps the best in terms of experience and expertise and has helped complex cases. Once he obtains my husband’s medical reports from Stanford he could tell us if my husband’s case is treatable by those therapies. It is not covered by Medicare and his supplemental UHC insurance though.
If you have any insights you would like to share please do so. Listening to patients tips and experiences prepares other patients not to make mistakes. I saw the link in this group about Estrogen Patch instead of ADT . Dr. Mark Scholz from non-profit that educates prostate cancer patients doesn’t talk about using estrogen patches. Is using estrogen patch better from point of view of side-effects or only cost?
There is another member from this group who pointed out to me that that Dr. Mark Scholz omits LOTS of details in his videos. I wonder what are those details.

I’ve had both knees replaced since I started ADT. It was not a factor in having my first knee replacement recovery. What was a factor was that I didn’t do any weight exercise for the first six years I was on ADT. As a result my muscles were quite weakened when I had the second knee done. My first knee replacement was after being on it for three years. I recovered completely in the normal amount of time. The second knee took quite a bit longer, but once I recovered, I was able to run for the first time in many years. Previously, I would just fall on my face if I tried to run.

Dr. Chuck Roach at UCSF would be my preference. He did my brother‘s radiation and he also did the radiation for Rick Davis, 14 years ago, who started Ancan.Org A place you could get a lot of information about future treatment. They have weekly advanced prostate cancer meetings, and he attends them all. Rick has been undetectable for the 14 years since his radiation.

The estradiol patch costs a fraction of what it cost for ADT drugs. Doctors make a lot of money giving you the ADT drugs they are thousands of dollars. My Orgovyx Prescription is cost about $3000 a month. Estradiol probably would cost about $30 a month. Lupron is at least $4000 a year. As a result until the patch clinical trial was done in England, no one wanted to test it since it wasn’t financially profitable to do it. If you watch the video and messages I sent to you, you will find a lot more information.

Check out the absurd pricing somebody recently had for Lupron
https://kffhealthnews.org/news/article/bill-of-the-month-shot-prostate-cancer-drug-testosterone/
By the way, I cannot use estradiol because I have BRCA2 and it can cause breast cancer and adding estrogen can make that happen faster.

And then there’s this from a UCSF doctor

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH

What about focal therapy? (HIFU, TULSA PRO and Cryotherapy )
* The energy modality matters much less than the accuracy of the imaging - which is not there yet.
* Overall focal therapy is associated with minor side effects, but high rates of recurrence both in- and out-of-field.
* Focal therapy is not really a replacement for surgery or radiation; it is better considered an adjunct to active surveillance

@jeffmarc

Jeff, @sriddle1 asked about gel spacer - do you know anything about gel spacer insertion for patients that have salvage radiation ?
Thanks in advance < 3

@surftohealth88
I have not heard of it being used for salvage radiation but here is an answer for you, it seems to make sense.

Using a gel spacer (like SpaceOAR) during salvage radiation after a prostatectomy is highly beneficial for reducing rectal radiation exposure and minimizing side effects. It creates a temporary, absorbable barrier between the prostate bed and the rectum, significantly lowering the risk of rectal injury, bleeding, and long-term bowel dysfunction.

@jeffmarc
It is good to know that hormone therapy will not interfere with post knee surgery recovery. It is also promising to hear that Dr. Roach from UCSF has treated Rick Davis successfully and that he is cancer free for 14 years. Do you know what Gleason score he had? Did he also take hormone therapy? Or did he take estradiol Patch?
I could ask Dr. Roach if he could agree to prescribing estrogen patch. I did watch that video where they talked about using estradiol.
My husband has a very high grade cancer according to PSMA PET/CT but it is contained within prostate. He has two Gleason 9 and two Gleason 7 unilateral. Brachytherapy either LDR or HDR ( what I understand from videos of Dr. Mark Scholz and some other radiation oncologists) appear to be least invasive in terms of urinary problems. ED happens with all radiation therapies unfortunately.
Are there some good ways to counteract ED caused by radiation and hormone therapy?
Will Decipher and another test will be able to tell if one has BRCA2 ? What is BRCA 1 & 2? I remember Dr. Scholz talking about these genetic stuff. I have to ask the radiation oncologist to order genome and genetic tests for my husband to make sure if he is predisposed towards prostate cancer. Also Prostox test can predict who will have more radiation side-effects.
I will talk about prescription for estradiol instead of ADT first and second generation drugs. Besides being cheaper does estradiol also effectively keeps testosterone and PSA in check and causes much less side-effects caused by ADT drug’s?
Thanks a lot for information.

@jeffmarc My RO said you don’t use it in SRT because cancer cells could be near the rectum and you need to get those too.
A barrier could actually protect these cells from the disruptive effects of the radiation. When your simulation is done under optimal conditions (full bladder/enema) the rectum is fairly collapsed; this allows them to get into that area directly adjacent and around the rectum so that the software of the radiation machine can actually ‘shape’ the beam to go around the rectum.
This is how my RO explained it and it sounds pretty cool when you think about it.
But this is why it is SO important to follow the dictum of ‘full bladder/empty rectum’…if your bladder isn’t distended enough or your rectum isn’t narrow enough (due to gas or feces), those beams are going to hit tissues that weren’t meant to be hit and that can cause cystitis and proctitis…Best,
Phil

I was treated at Mayo Clinic Rochester using Proton Beam SBRT. Spaceoar, a gel was used to shield the rectum from radiation. The bladder is protected by maximizing the space between the bladder and the prostate. This is accomplished by having the patient relive their bowels and then drink 16oz of water prior to radiation. The water extends the bladder enough to maximize the space between bladder and prostate.

@ambika
Rick Davis was a Gleason 8. I don’t remember him ever mentioning having ADT. You can ask him yourself on Tuesday at 3 PM Pacific time. If you go to ancan.org You can sign up for the meeting and get the newsletter. He sends it out every week. It has some pretty incredible information about the latest things going on in prostate Cancer treatment. You don’t have to sign up that you can just go to the meeting. You need to install GOTO meeting To attend the meeting. Type in answercancer as the name of the meeting. It’s available for every device. If you attend the meeting, get there 10 minutes early and you will be called on first to discuss your case and come up with Solutions. They’ve been doing this for 15 years and know a considerable amount. There’s always at least three doctors in the meetings.

If your husband has even one, Gleason nine, he is a Gleason nine the sevens are irrelevant.

The Urinary problems from radiation are short term in almost all cases. I had eight weeks of it and never had any urinary problems. Radiation seldom causes ED immediately, If you have surgery and they can spare the nerves that also can prevent ED. The thing is radiation, usually destroys the nerves, It’s possible to get an erection for a while, but eventually it goes away for most people.

Hormone therapy takes away the desire for sex and for most people prevents getting an erection. You can work around it by using a penis pump or the most successful thing is Trimix or Bimix. That requires injecting it into the penis, but it is a very small needle and really causes minimal pain. That can get him an erection for a couple of hours. You can also have an implant installed, Works quite well and Has a high satisfaction rate.

A decipher test does not test for genetic problems. You want to get an hereditary, genetic test? It is covered by insurance and most medical facilities will do it. They always have to send it away To be analyzed. Just tell your doctor you want one. If there is cancer in the family, Breast cancer, Pancreatic cancer, Prostate cancer and others then it is more likely that he would have a genetic problem and doctors would Desire to have the test done. Another reason you want to do it is you wanna make sure your children don’t have a genetic problem inherited from him. I inherited mine from my mother.

Estradiol is just as effective as ADT to keep testosterone down to Very low level levels. Do some searching for the Patch clinical trial, That’s the one that showed it definitely works. It has not been approved by the FDA because no one wants to run the test in the USA since the product is so cheap to buy. Richard Wassersug Who wrote a book on ADT has been on estradiol for 22 years, he has not become castrated resistant and has almost no testosterone. It is kept his cancer at bay all this time.

BRCA2 is a genetic hereditary problem that causes an Increased risk of prostate. Breast and pancreatic cancer, As well as a few others cancers. There are a number of genetic problems that caused similar issues. You can look up BRCA2 on the Internet and you will find out a lot of information. I got prostate cancer at 62 because my father died from it, and my mother gave me BRCA2. My brother got it at 77 because my father died from it But he didn’t have BRCA2.

Having a parent or sibling get prostate cancer increases the risk of getting it by over 100%.