HDR Brachytherapy at UCLA

[ocman]

I had my 2 procedures of HDR Brachytherapy (monotherapy) on 2-7-20 & 2-14-20.

I had some really bad burning during urination for about 2 weeks, but the Pyridium saved me. I was also prescribed Flomax for one month, which was a big help. I have no incontinence and expect no ED, but was in pain urinating until a couple of days ago and wasn't even thinking about sex.

Might I digress, I went into the procedure at a level 10, but when I left I was at around level 7. The Radiation Oncologist recommended the SpaceOAR hydrogel, which sounded great. I saw the Radiation Oncologist on 12-13-19 and decided to have the 2 treatments and scheduled it that day for 2-7-20 & 2-14-20. I get a call from Nurse A on 1-29-19, approximately 10 days before my procedure and she tells me that they failed to submit the request for the authorization for the procedures, but she was going to make sure it happened. I was getting nervous by now. I get a call from Nurse A the next day and she said it was denied by Anthem Blue Cross, but the RO was going to have a peer-to-peer with Anthem later that day. I said to make sure they did the peer-to-peer for the SpaceOAR hydrogel and she said yes. The next day, I called and asked for a Supervisor and got Nurse B, she said Nurse A was no longer with UCLA (oh great!). Nurse B said the request for authorization for the procedure was sent in on 12-30-19, not 6 weeks later like Nurse A said. I get a call from Nurse B on 1-31-19 and she said everything was approved.

I get to UCLA for my first procedure on 2-7-20, I’ve got my gown on, sitting in the gurney, had blood drawn, and an IV inserted and the RO comes in and says the SpaceOAR hydrogel wasn’t approved. I wasn’t too happy that they waited until then to tell me about the SpaceOAR gel. I found out that UCLA knew on 2-1-20 (Saturday) the SpaceOAR gel wasn’t approved and they failed to inform me. I felt like it was bait and switch by that time.

The RO said, there was low toxicity to the rectum without the SpaceOAR gel and he would use FloSeal (used to stop bleeding) to create the space between the prostate and rectum. The RO said I really didn’t need the SpaceOAR gel, I said why did you recommend it then? After pondering for 15 minutes I decided to go ahead with the procedure. I had missed 2 days of work, had a ride lined up, family was there, I was extremely disappointed. Also, Nurse B wasn’t correct when she said the request for authorization was submitted on 12-30-19, it was actually submitted on 1-20-20 (which was actually 5 weeks late not 6 weeks).

The RO said that starting this year Anthem says they won’t approve SpaceOAR gel. I told Nurse B and the RO that my son in law is a lawyer and he fights insurance companies for a living and if they would’ve informed me in a timely manner, he would’ve contacted Anthem and possibly got the SpaceOAR gel approved. He even sent me the caselaw regarding the denial.

Anyways, I needed to vent. I was hoping for a much more positive experience.

peace

[Tall_Allen]

SpaceOAR certainly isn't worth getting into a fight over. It's benefit is modest, if at all. (I think of it as a cure in search of a disease). I'm particularly down on it because I believe it protected my friend's cancer from radiotherapy. It pushed some cancer against the rectal wall where it flourished, became untreatable, and caused him all kinds of problems. Here's my analysis of the SpaceOAR research. I think you should be glad insurance is balking.

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

Recently, it was analyzed and found wanting in Canada:

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

There are some scary case studies:

liebertpub.com/doi/10.1089/...

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

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

[timotur]

I wish I had a dime for every time TA posts something negative about SpaceOar. I'll give you first hand experience, I had SpaceOar with absolutely no complications for HDR-BT at UCLA. Imaging showed Dr Chang placed it perfectly symmetrical giving about 11 mm separation between prostate and rectum. I'll take that and the chance to reduce radiation to the rectum anytime. If you get a good RO that has done it successfully many times, chances are it will be beneficial.

ncbi.nlm.nih.gov/pubmed/292...

ncbi.nlm.nih.gov/pubmed/292...

ncbi.nlm.nih.gov/pubmed/225...

Anyway, sorry to hear about this unfortunate mess-up at UCLA, sounds like an admin f/u, and the RO tried to play it down. The timing sucks-- telling you at game-time just before the procedure with an IV in your arm.

If there is any consolation, since your tx was HDR-mono, the benefit of SpaceOar is probably less because the local HDR radiation field can be controlled via dwell times to avoid rectal damage (imo, it's a greater benefit for external radiation like IMRT).

[ocman in reply to timotur]

Yes, it was totally an administrative f/u...Do you know how HDR-mono would effect the rectum if not done right?

[timotur in reply to ocman]

My guess is the RO would have compensated during the CT mapping process to lessen the radiation amount at the posterior boundary of the prostate compared to as if the SpaceOar had been there. There will be a 30-day followup and you could ask specifically if this was done and/or if it is mentioned in the RO's notes. Another factor is the extent of the tumor in the posterior prostate and how much radiation needed to be applied to that area. Your original biopsy and MRI would give an indication of the tumor extent at the posterior boundary.

[ocman in reply to timotur]

What would you ask for to get those notes?

[timotur in reply to ocman]

The physician assistant called me for the followup, and she read them to me over the phone. I would ask whoever calls you to read them or put a copy into your MyUCLA portal.

[ocman in reply to timotur]

I got a call from someone yesterday, they wanted to set up a 90 day appointment.

[timotur in reply to ocman]

My procedure was June 05 and follow-up phone appt wasJune 24, about 3 weeks later. Can't speculate as to why yours is 90d other than mine was a one-day procedure and yours was two-sessions, so there was a built-in follow-up.

[ocman in reply to timotur]

Forgot, I did have a follow up phone call at 11 days. Next is PSA test and follow up appointment at 90 days.