Is putting in the fiducials & gel in spaceoar painful with SBRT Treatment?

[JWS13]

If you are having SEDATION with Spaceoar is the placing of (markers) FIDUCIALS and the GEL painful?

Are "markers" in Proton the same as "Fiducials" in SBRT?

Someone had proton radiation and posted that the placing of the gel was "nothing" but the placing of the "markers" was the most "excrutiating " pain he has EVER felt?

Nobody else has ever made this comment..is this accurate?

Thanks ..all responses appreciated.

[Cdubu]

Under sedation I had both fiduciary and SpaceOar placed 2 weeks ago by Dr Zelefsky at MSK. There were no after effects, none.

I was instructed to not lift anything over 25 lbs for a week after by Dr.

The nurse suggested 2 weeks and to not strain when defecating

[Yearofthecow]

I had Space Oar at UCLA, and they give you lidocaine for pain, and an antibiotic prophylactic. It was somewhat uncomfortable , but not too bad.

In general you can’t judge what your experience will be based on what someone else had, because everyone reacts differently to pain.

If you have had a prostate biopsy, it should be about the same

There is also a small chance that the peri-rectal space may not open , and if that happens, the procedure will be terminated, and they won’t insert the hydrogel

I didn’t have fiducials it in because I went through Viewray, MRI guided SBRT, however, the fiducial implant should be similar to a prostate biopsy, but implanting the fiducials in, instead of taking tissue out, so one would think it would be less traumatic

[Seasid in reply to Yearofthecow]

What was the radiation dose you received during your MRI guided SBRT treatment?

[Yearofthecow in reply to Seasid]

SBRT to prostate 40 Gy/ 5 fractions

[Seasid in reply to Yearofthecow]

I am getting the same. But I have to check if it is 38 Gy to the prostate? Also in 5 fractions. In how many days did they delivered it? I hat 2 fractions this week on Wednesday and Friday.

Next week i should receive it on Monday and Wednesday.

Nothing on Friday next week as the MRI Linac is undergoing maintenance. Hopefully the last fraction will be delivered Monday a week after next week.

I am not getting any space or or similar.

[Yearofthecow in reply to Seasid]

yes that is standard protocol every other day, excluding weekends.

and if the machine is down, a delay for a day or two will not affect the outcome

All the best

[Burk]

Hi JW, I assume you had a biopsy. The placing of fiducials is almost the same procedure as the biopsy. A lot depends on the expertise of your urologist. They normally numb the area with Lidocaine.

I had a 12-core biopsy and fiducial placement - both transrectal. A little sting but nothing like I hear some fellows report. General anesthesia seems like an overreaction to me.

[Burk in reply to Burk]

Did not have space oar.

[Hidden]

I went through the process before my IMRT. I had both the gold markers placed as well as the SpaceOAR. I was on my back on a table with my legs in stirrups and my bum well exposed. I was wide awake for the whole procedure, no sedation. It started with only the ultrasound tech in the room. He put the probe up in me then used short needles to numb the immediate area of the perineum and 6 inch needles to numb the whole area around the prostate. He turned the screen towards me so I could watch what he was doing. I did have a cute little Asian nurse that stood beside the table to comfort me and keep me company. There was a sheet draped over my knees and legs so I could not see the people that were doing the procedure. After a while, I knew there were at least two other doctors that came in the room to do the actual placing of the markers and gel. It took a while to complete it and somewhere during the process, I kinda sat up a bit to get a look over the sheet. OMG!!! There was an audience of about 6 people observing including a good looking young white girl. I think she was the rep for the SpaceOAR company. She gave me a big smile as if to say, yes I see your bum. I found out later that this was a teaching center so the door to the room was wide open and anyone walking by could stop in and take a look. There was no real pain during any of this, just a little stick and sting at the first numbing injections. After this procedure, I went directly to another room that had a CT scanner. This is where they did the "simulation". Another procedure that strips you of any dignity that you may have left from the previous procedure.

[Tall_Allen]

I've had 3 fiducials (no SpaceOAR). Similar to biopsy, except only 3 and putting the small gold grains in hurts less than pulling tissue out in a biopsy.

[leach234]

You’re beating this topic to death?

[John347]

I had fiducials and SpaceOar gel inserted about 4 months ago under general anaesthesia. In and out of the operating theatre in about one hour. Didn't feel a thing. That was about 2 weeks prior to commencing IGRT.

[JWS13 in reply to John347]

Was it general anesthesia or twilight..fentanyl, versed, etc. (like a colonoscopy)...tx

[Victor93 in reply to JWS13]

”Moderate” sedation here, fentanyl. Unconscious but quick recovery. Easier than the biopsy.

[cesces]

I keep hearing unkind things about the space oar.Not that it is harmful, but that it is useless.

[Hidden in reply to cesces]

I had no idea of how the IMRT that I had was performed. After having gone through the IMRT treatment, I would not have had the SpaceOAR implanted. The gel sits between your prostate and your rectum. When the radiation machine is straight overhead, the gel will give some protection. The machine goes all the way around you 360 degrees so once it leaves the straight overhead position, there is no protection. Even the Urologist I saw told me that it was a "money thing" and he didn't think it was worth the effort.

[qb111 in reply to Hidden]

My understanding of how the spacer works is by pushing the rectum farther away from the prostate, which provides a greater margin so that planning can fully radiate the prostate without hitting the rectum. This isn’t just for the incidental radiation from top down targeting of the prostate, but also when the beam is hitting the prostate from the side. Breathing, gas in the colon/rectum, and breathing can move things around, and the rectum could move into the field of the radiation dose intended for the prostate. With MRI guidance as well as modern IMRT planning, there is a low risk of problems, but spacers do reduce that even further.

[Yearofthecow in reply to cesces]

Anecdotally the space oar should help decrease the amount of radiation that might travel through to the rectum. That is what my radiation oncologist suggested, and while it is optional because of the accuracy of current radiation protocol, he believes it offers some protection, and if insurance covers it, and you have hemorrhoids or other issues it might be a good idea to have

[climb4blue]

The gold fiducial placement was very painful, however, it was over in about 1 minute. I can see both sides of the sedation debate. Personally, I would have chosen sedation, but I can see how the risks of sedation may not justify averting the pain from the 1 minute procedure.

I learned from it though. I know it is my prostate recovery when experiencing painful sensations at the tip of my penis because that was how the pain represented itself during fiducial placement. It has been 8 months since my SBRT treatment at UCSF, and burning sensation flare-ups occur randomly at the tip of my penis, so I just attribute it to prostate inflammation from radiation that is still doing the job and don't get too upset about it.

[Scooter22]

Biopsy, fiducials & spaceoar all totally painless for me at Duke Cancer Center