SBRT fiducials antibiotic: Scheduled... - Prostate Cancer N...

Prostate Cancer Network

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SBRT fiducials antibiotic

Sunfire
Sunfire

Scheduled for SBRT 5x in Jan/Feb. markers and Spaceoar placement. Prescribed Augmentin 875 mg. 1x per day over 2 days per RO. When given biopsy used Bactrim with no issues 1x per day over 3 days per Urologist. Concerned regarding proper antibiotic. Cipro or any flouroquinolone antibiotics off table with allergy. Anyone have experience using Augmentin for biopsy or fiducial/spaceoar placement?

11 Replies

I had three fiducials inserted into my prostate gland prior to IMRT.

Sepsis is less of a concern with transperineal fiducial placement.

I'm not a fan of SpaceOAR:

liebertpub.com/doi/10.1089/...

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

pcnrv.blogspot.com/2017/01/...

What really turned me is the experience of a friend. SpaceOAR was inadvertently injected into part of his prostate tumor abutting his rectum. It "protected" a part of the tumor from his radiation therapy, while the rest of his prostate tumors were destroyed. It progressed and is now giving him all kinds of problems. Because it was pressed into the rectal wall, it is almost impossible to eradicate now.

Sunfire
Sunfire in reply to Tall_Allen

Thanks for the info on the antibotic I thought that but wasn't sure. So sorry to hear about your friend. Thanks for sharing. SBRT without spaceoar is highly recommend. I have several friends that had zero bowel issues and say it was a lifesaver in terms of side effects. As I understand it does have potential complications however data does suggest it surprisingly protects bladder and erectile function too. I'm still on the fence with spaceoar. I hear nightmares both with and without.

Tall_Allen
Tall_Allen in reply to Sunfire

Read my analysis. I did not have SpaceOAR, and had few bowel symptoms. It is a cure in search of a disease.

Sunfire
Sunfire in reply to Tall_Allen

Will do and good to know. Your opinion based on research and experience is much appreciated.

Stevecavill
Stevecavill in reply to Sunfire

Re SpaceOAR: A tiny number of adverse events does not indicate a procedure is unsafe. It does indicate the skill of the surgeon is important. Similarly a personal experience of not experiencing side effects from a procedure does not mean the side effects are not common. Some men do not suffer erectile dysfunction after prostactectomy. But ED is VERY common after prostatectomy.

My Rad Onc explained the major benefit to the Rad Onc of the spacer gel, is that they can plan a larger target volume to ensure they hit the whole prostate tumour, without worrying about the damage to the rectum. i.e. they can go OUTSIDE the prostate, knowing they won't hit the rectum with a high dose of radiation. This is particularly useful if the lesion is adjacent to the rectum, which is pretty common.

This study was written by my Rad Onc : onlinelibrary.wiley.com/doi...

I had fiducials and SpaceOAR placed this past August and completed my last SBRT (Cyberknife) treatment before the end of the same month. My fiducials were stranded so I have a total of four. Coincidentally, the SpaceOAR rep was in the OR during my procedure although my URO has placed dozens of them. Not sure the rep had anything to do with my procedure. My RO won't treat with Cyberknife without the spacer. For my biopsy and fiducial placement my URO administered an antibiotic via an IV line during the procedure. I had no oral antibiotic before or after either procedure. I have read the data on SpaceOAR and agree that there is no convincing determination of the efficacy. Even so, I decided on it ahead of time in the event that long term reviews show a benefit.

I went with all the above because after much research I had determined it was the best option for me given my particular disease level. I had second opinions at a leading cancer treatment center in my state and decided against surgery and the more conventional IMRT treatment plan. I was offered a position in a trial that included either SBRT with a Varian machine or the IMRT treatment plan. I declined the trial after deciding against IMRT. I particularly liked the total process used by my URO and RO. Bottom line...dive deep into the specifics of your recommended treatment plans. I was surprised by the variety of methodologies used by different URO's to place fiducials. So far, I haven't read any information analyzing problems with the spacer that included a possible correlation with the method used for placement.

I am ten weeks out from my last SBRT treatment. I had a very minimal slowing of my urinary stream for about the first two weeks after radiation. Otherwise, no side effects. I attribute this to my treatment plan, along with my diet and exercise.

Sunfire
Sunfire in reply to tnone

Great information. Thanks for sharing.

Sunfire
Sunfire in reply to tnone

Did you have any urinary issues with BPH prior to treatment?

The trigger for me overall was a slowly rising PSA, which resulted in the referral to the URO. I had no symptoms at all. I'm 64 and have always slept through the night without having to empty my bladder. After my initial consult with the URO I had a mpMRI which showed a PIRADs 4 lesion and "diffuse prostatitis". Again, I never felt any physical symptoms and DRE exams were negative. In hindsight, my PSA levels over the last few years did fluctuate up and down in a narrow range. That fluctuation is more consistent with prostatitis, but my PSA always stayed below 5ng. My "free PSA" was low-normal however. MRI showed my prostate volume to be 32ml, which is average in size for my age. My urinary flow before diagnosis and treatment was good. I believe the RO scored me relatively high on the EPIC test, which grades your overall urinary function. After about ten weeks post radiation, my urinary function is every bit as good as it was pre-treatment. So, in answer to your question, I have not have any BPH issues.

Sunfire
Sunfire in reply to tnone

Great news for you. Concern here is SBRT treatment with an already enlarged prostate with slow flow. Already on Flomax so here's hoping all goes well.

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