Rectal hydrogel spacer for PCa radiotherapy

[tunybgur]

I understand that a rectal hydrogel spacer injected into the space between the rectum and prostate is effective in significantly reducing the danger of collateral damage to this area during radiotherapy.

Is this now a standard treatment on the NHS or is it still under trial?

Does anyone have any knowledge or experience of this treatment?

I am very shortly due for 38 sessions of radiotherapy on my prostate and I'm very seriously considering having this barrier fitted privately if it's not available as a treatment from the NHS, why wouldn't you?

[Tall_Allen]

It does not "significantly reduce the danger of collateral damage." Late term rectal side effects are seldom an issue. I call it a cure in search of a disease. Canada wouldn't approve it, and I assume that NICE wouldn't approve it in the UK.

[tunybgur in reply to Tall_Allen]

Thanks for replying Allen, interesting that Canada wouldn't approve it, do you know why?

I'm sure the incidences of damage to surrounding tissues are small, but reading some of the horror stories on this forum it does raise some concerns, probably too much information and not the whole story?

[Tall_Allen in reply to tunybgur]

I'm not sure which "horror stories" you are referring to: (1) rectal ulcers from the gel infiltration and preventing the cancer from getting radiation or (2) rectal injury from radiation.

Here's the recommendation to not approve it in Canada:

muhc.ca/sites/default/files...

And some real world data:

auajournals.org/doi/10.1097...

[skiingfiend]

I'll just contribute to the approvals part of this discussion.

NICE approved it for coverage under NHS on Feb 2023

nice.org.uk/guidance/ipg752

It has been approved in Canada since 2016. Uptake in coverage under Provincial health plans has been slow and spotty. BC is leading the way, Ontario also covers it, Quebec has decided against coverage with exceptions (TA's link above is related to this decision).

Here is a BCCancer press release from 2019

bccancer.bc.ca/about/news-s...

[tunybgur in reply to skiingfiend]

Thanks for the links, they seem to give a more up-to-date status on this procedure.

I shall discuss it when my appointment for RT preparation comes up.

I know some of the latest RT machinery is much more accurate, but I think a lot still relies on the skill of the operator.

[skiingfiend in reply to tunybgur]

I just posted a recent talk about RT that includes a discussion about spacers (see part 1).

healthunlocked.com/advanced...

[tunybgur in reply to skiingfiend]

Thanks! It was really interesting....food for thought.

My only concern is, how do I go through all of this without becoming a real irritation to the professionals treating me?

My first appointment to discuss radiotherapy is in a few days time.

In the leaflet covering External Beam RT from Prostate Cancer UK it does have a section on rectal spacers and suggests it's something to discuss with the doc.

If my centre (Southend Hospital) doesn't cover this treatment can I request it being done somewhere else, or have it done privately?

[skiingfiend in reply to tunybgur]

Sorry, I can't say, I'm in Canada. Maybe make a new top level post with your question and see who responds.

[Derf4223 in reply to tunybgur]

Educate yourself about trials and treatments applicable / approved / covered for your particular kind of PCa. When you talk with your doctors, have prepared notes, no more than a few topics, and cite trials. Become familiar with the NCCN SOC treatment guidelines, which changes frequently. You won't be an irritant if you can be organized and mention a relevant trial or 2-3.

Ask your doctors for a DEXA scan. If you haven't, start resistance, cardio and aerobic exercise. Clean up your diet -- diabetes and heart disease worsen PCa.

[tunybgur in reply to Derf4223]

Thanks for the advice Derf, I am putting my file together, I shall be asking several questions, focussing on the key areas, although I'm not sure how to frame a question asking how their success ratings compare, I think oncology requires a lot of skill from the operator....

It's the first time I've heard of the NCCN, interesting stuff there.

I've always kept myself pretty fit (for a 75 yo), and since my diagnosis of PCa, I have made a lot of dietary changes to try and create a hostile place for cancer cells, how effective this is I don't know, but it makes me feel a lot better, fortunately I like Brussels sprouts, but Garlic very nearly cost me my marriage!

Thanks for your help

[MarkS]

I sat next to someone a week ago who had PC, had radiotherapy and did not have the spacer. He has had to have some of his rectum remover and now has a bag. I'm going for radiotherapy and will be getting a spacer inserted. That's privately rather than the NHS who I have been very unimpressed by.

[tunybgur in reply to MarkS]

That's the sort of thing I'm concerned about.....and with 38 sessions to look forward to....I really would like some accurate statistics. I had read that the spacers reduce the chance of subsequent RT problems by 70%.

[MarkS in reply to tunybgur]

In this review:

goldjournal.net/article/S00...

The late gastrointestinal toxicity is reduced from 6% to 1% and late genitourinary toxicity from 32% to 15%. The results of the only known RCT are shown lower down: "At 36-month follow-up, Grade ≥1 rectal toxicity was 2.0% vs 9.2% (P = .028) and Grade ≥2, 0% vs 5.7% (P = .012) favoring the spacer arm. From 6 to 36 months, fewer men experienced clinically significant declines in all 3 EPIC-QoL domains, ie bowel, urinary, and sexual (2.5% vs. 20%, P = .002)".

I'm getting treated at GenesisCare where spacers are included for free. This is their booklet on spacers:

genesiscare.com/uk/treatmen...

[tunybgur in reply to MarkS]

Thanks Mark, that's really useful data, if I can't get it on the NHS I shall try and get it done privately, provided my consultant agrees.

[j-o-h-n]

Radiation - I've posted this before so to those people who have already seen this please forgive me. (Second time today).

I had 8 weeks of salvage radiation to "the bed". 5 days a week (not weekends) for 8 weeks minus 1 day for a total of 39 sessions at MSKcc. The actual radiation was like getting an x-ray by my dentist. I never had any side effects during the whole 39 sessions. However, 2 years later my left urinary tract was "fried" as per my urologist (or from passing prior kidney stones he was not sure). So, I had to have a urinary stent placed up my urinary tract (through my willy which is really nothing - sounds terrible but it's nothing) to aid in passing my urine (which was never a problem anyway). So I had stents in and out every three months for many years and now I'm stent free, However today 15% of urine from left kidney and 85% from right kidney, but not a problem. So make sure you get a good radiologist. Also, I don't know if this would apply to you but SOME guys here recommend SPACEOAR HYDROGEL to be inserted for protection of parts of your body. Make sure you ask your R.O. about the space oar and make sure you ask here on this forum before getting fried. (You're already asked).

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 12/03/2023 10:34 PM EST

[tunybgur in reply to j-o-h-n]

Thanks John, unfortunately with the NHS I don't think you can pick and choose your radiologist, and I do understand the outcomes are very much dependant upon the skill of the operator, therefore my interest in spacers.