IMRT WITHOUT THE JELL

[woppaginny]

I'm scheduled for IMRT Radistion without the jell. Doc says the jell may push cancer microscopic cells away from the prostate. He said the cancer is about to protrude through the capsule and microsopic cancer cells could be out of the capsule and did not want to take a chance of putting the jell in and pushing microsoplc cancer cells that could be outside the capsule away from the prostate capsule area. My questjon is has anyone had IMRT prostate Radiation without the jell being inserted and if so what were the side affects like without the jell being injected.

[Tall_Allen]

SpaceOAR wasn't used before about 2018. I had SBRT in 2010 and had zero long-term rectal issues. It is oversold to patients, IMO. And you have a wise RO because that is indeed a major concern.

[timotur]

You won’t know if SpaceOar was worth it until a couple of years later if and when radiation proctitis shows up in your rectum. It gives you about 14mm average separation between the prostate and rectum. That’s a mile in radiation plan mapping and provides a sharp cutoff in adjacent field effects. I don’t buy the explanation that SO pushes microscopic Ca cells out of the prostate because if the tumor is growing, Ca cells will do so anyway. I had SO with HDR-BT/IMRT five years ago, and didn’t wind up with radiation proctitis, verified by a colonoscopy a few weeks ago. Good luck!

[pd63]

In the UK spaceoar or similar is not recommended by NICE

[treedown]

I had 80gy 45 treatments IMRT no gel no side effects coming up on 4 years since my last treatment.

[London441]

I had IMRT at a major center of excellence in 2019. I was not given spaceoar. When I heard of its use shortly after starting and asked my RO about it he gave a similar explanation. I have had no issues.

There is definitely no consensus about its use among experts.

[vintage42]

In 2021 I saw that my hospital chain featured SpaceOar on its website. I asked my RO if I should have it with my radiation, and he said they had stopped doing it. He showed me my MRI which showed a little clearance between my prostate and rectum, which he said would be safe as opposed to cases where the prostate was pushed into the rectum. So I took 30 IMRT with no side effects in three years.

Googling, I found that SpaceOar was proprietary, cost $2,500, and carried risks, at least as of 2019.

liebertpub.com/doi/abs/10.1...

urotoday.com/conference-hig...

[janebob99]

I'm in the same boat as you.

I plan on doing SBRT (5 sessions spaced apart once a week) in a few months. My RO showed me on the MRI that my tumor had not gone outside of the capsule, in contradiction to the radiologist's MRI report. He believes that using a rectal spacer gel is safe in my situation.

You may want to get a second option from a different radiologist about the extent of your ECE. Your RO can provide the name of a respected radiologist to give a second opinion.

I also receive a second opinion from a very well-known RO at UCLA that the concern about trapping PCa cells next to the rectum was a "theoretical concern", meaning that very few actual cases have been reported. I'm only aware of one case of a rectal problem (N=1).

Given the large number of rectal spacer RT operations performed every year (many thousands, at least), if it was a significant problem over the past 10 years or so, then it should have been reported by now.

You could look for such reports in the published literature.

Let me know if you find any.

Bob

[doc1947g]

I was 72 years young when I had VMAT-RT 3Gy X 20 fx without SO and 5 years later: no problem and PSA = 0.01μg/L .

[Adendino]

My husband also didn’t have the gel put in for the same reason. It’s been 12 months since his radiation was completed and he has zero side effects.

[AlvinSD]

I had 28 IMRT sessions in Dec 2022- Jan. 2023 and did not have SpaceOar. My RO did no want to use it for that reason. I’ve had no issues since despite not having it.

[EdinBmore]

No space oar. Uro said that, given number of biopsies that I had had, it was better not to use it. I had 25 IMRT fractions in 2018. Do not know if related to not having space oar but two rectal issues: frequency and urgency. However, I have learned how to compensate (i.e., watch what I eat, know availability of toilet, and take Imodium prior to any extended journey. It's a hassle but condition has improved but still...lucky thus far but some close calls, as it were).

EdinBaltimore

[Xavier10]

Another option is to reduce radiation intensity and increase number of visits.

[Jazzman2023 in reply to Xavier10]

That's exactly what my RO is saying. In the 44 vs. 28 discussion, 44 treatments would not require space oar gel, but 28 might...Both sets of treatments end up with the same total radiation dosage, but 44 has less in each dose. he prefers the 'slow steady' approach of 44 fractions, and claims he sees less side effects with 44.

[Xavier10 in reply to Jazzman2023]

exactly what my RO did. I couldn’t have the space oar due to a previous procedure, and he said there was a risk of ulcerating the rectum or something like that. So I just did the extra times and didn’t have any problem at all.

[JWS13]

I had 20 imrt at center of excellence..offered spaceoar..declined..no SE's whatsoever...Wish I could say the same for the useless ADT they put me on fo 4 months..g-7 ..latest study says that in intermediate..NO BENEFIT TO OVERALL SURVIVAL (for G-7's) and been 9 months and my testosterone has not recovered at all..

[doc1947g in reply to JWS13]

7, it depend which 7.

(3+4=7 Grade 2) = No need of ADT

(4+3=7Grade 3) = NEED of ADT 4 to 6 months.

[JWS13 in reply to doc1947g]

NO NEED WHATSOEVER-- 4-3 or 3-4...there is no life survival benefit for intermediate unfavorable or intermediate favorable. Newest study. Unnecessary ruins lives for a number of people (over 60) as Testosterone will not recover at all, then forced to take trt and get into that rat's nest of whether or not it will trigger a reoccurrence.

[Mgtd in reply to JWS13]

You make a really bold statement about not needing ADT if you are Gleason 7. Could you please do us 7s a favor and provide the source for your statement. Thanks.

[JWS13 in reply to Mgtd]

go to pcri.org and look up dr.mark scholz video on adt and new random study out regarding no overall survival benefit for both favorable and unfavorable gleason 7. (sorry dont have link).

[Mgtd in reply to JWS13]

Thanks

[j-o-h-n]

Here I go again

Hello Mr. Dago 🤡,

My age at the time was: 68 + years old (Fried during Feb. March and April 2005).

Greetings: Radiation - I've posted this before so to those people who have already seen this please forgive me.

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 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.

Good Luck, Good Health and Good Humor.

j-o-h-n