My Kaiser RO does not recommend hydrogel spacers for radiotherapy, of the prostate, distant and far lymph nodes which was recommended in a second opinion fromUCSF. When we first talked he said “for my condition prostate radiation alone is the science proven treatment but he would do prostate with near and far nodes if I wanted”. I am scheduled for set up tommorow and Fri. for treatment. I already have gold markers When I brought up hydrogel therapy again yesterday he curtly said “ I thought we discussed that at one of our visits and I explained that it's not something we routinely use with our VMAT plans. If your goal is to reduce potential treatment-related toxicity, then I'd recommend treating only the prostate which is what the best available science supports for a patient with your disease distribution and volume.” I think he does not like the idea of this plan which I brought to him from USCF and my Kaiser MO agrees with. I could postpone at the Alter last minute and move to UCSF. But I would have to change insurance and jump through hoops, it would take at least two or three months, I’m feeling I want to go ahead with Kaiser, I don’t believe an experienced RO would not do his best. The rest of my Kaiser treatment has been top of the line. Any thoughts on either gel spacers for this treatment or whether I should be concerned about my doctors forthcoming plan?
Radiation and hydrogel spacer and RO - Advanced Prostate...
Radiation and hydrogel spacer and RO
The spacer has only a very minor effect on rectal toxicity, if any. It should in no way dictate your treatment.
This is the clinical trial you may want to enroll in:
I agree with TA. I had both HDR Brachytherapy and EBRT including nodes up-to the paraaortic nodes. I did not have the spacer gel. My treatment was done at MSK. I’m 2 years out and have had no significant side effects to date.
I’ll give you the other side of the coin. SpaceOar gives you about 14mm separation between the prostate and colon. Ask your RO if he can guarantee your colon won’t receive as much radiation without SO as it would with SO, and see what he says. It’s impossible for it to receive less without SO— 14 mm is a mile in a radiation mapping plan. I had SO almost five years ago and have no toxic radiation or physical SE’s.
Here the criteria which must all be met for SpaceOAR
SpaceOar Hydrogel procedure, are typically required when all of the following criteria are met:
The patient has been diagnosed with invasive adenocarcinoma and/or intraductal carcinoma of the prostate and is at risk of experiencing long-term side effects following radiation therapy
The patient does not have extracapsular extension of his prostate cancer through the Denonvilliers’ Fascia posteriorly to involve the tissues of the rectum
The patient does not have an underlying condition such as perirectal disease or other anal or perianal diseases such as fistula
The patient does not have an active inflammatory or infectious condition affecting the perineum, gastrointestinal or urinary tract
The patient does not have an urogenital abnormality that would interfere with the ability to access the injection site or place fiducial markers
The patient does not have a gastrointestinal abnormality that would negatively affect the ability to access the injection site or place fiducial markers
The patient is not allergic to local anesthetic
The patient does not have any preexisting comorbidities (e.g. cardiac disease, pulmonary disease, etc.) and/or a high risk of bleeding.
What are you going to think if you had a spacer and then a met shows up on/near the rectum? You would not want the spacer to protect the cancer cells on the other side of the spacer. Anyway, there is very little effect if you don't have the spacer and and whatever mild effect it does have goes away when the treatment stops.
Good point, but I was run over, if i was told that was a possibility I may have said no to hydrogel - but don't keep me in the dark, the stakes are large. The reason I'm in this situation is because my psa was 4.1 in 2013 and K never said it was an issue and never gave me another PSA test until I had symptoms in 2022 and it was 300. I was stupid at that time, that's on me but it will not happen again. Above all be your own advocate!
I believe you previously mentioned that you have had fiducials placed ? If so, did your Kaiser RO suggest those, or did you need to mention your interest in fiducial markers? I ask because several other Kaiser patients have mentioned that their Kaiser Docs did not advise fiducials, saying that CBCT provides accurate daily imaging.
My RO recommended gold markers.
I had IMRT in Dec 2022 / January 2023 with no SpaceOar and have had no issues at all.
I know Kaiser really seems to discourage its use (based on feedback from other patients) which I feel is based on Kaiser’s cost consciousness. One guy I know had SpaceOar strongly recommended at a non-Kaiser second opinion and he really had to push Kaiser hard to get them to agree to it.
After the fact I have realized that the RO was personally upset that I had brought a novel treatment to him without consultation, whereas he is all about SOC. I had told my MO I was going for a 2nd opinion and she thought it was a great idea, the radiation was only part of that 2nd opinion and it was months before having an RO assigned. Maybe I could have handled it better, but he has not acted professionally.
I had gold markers placed due to bilateral hip replacement. Spacer was injected at the same time as the markers and it was not pleasant. I have read impact is minor and I would not get spacers as a second procedure.
I had local salvage radiation long before the spacer was available, and have had very minimal side effects that are almost not worth mentioning.
Kaiser philosophy tends toward one size fits all, which can be problematic for advanced cases. If you can afford it, I would at least add another oncologist from outside of Kaiser to my medical team.
I had hydrogel SpaceOar inserted prior to my prostate radiation. The risk of rectal burn (proctitis) from the radiation is small... perhaps less than 10%... but why take the risk? Proctitis is a life long complication from rectal burns.This excellent video from PCRI may enlighten you further...
thank you
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