Has anyone here been told by their Rad Onc doc that they would be hesitant to use SpaceOAR due to having greater than 50% positive cores? Or not even consider SpaceOAR if there was greater than 50% pos. cores?
Has anyone seen any studies where patient(s) with greater than 50% positive cores, that was treated with SpaceOAR, was found to have a negative impact ?
Apology in advance if this has been tossed around before. Saw some other posts, but did not see this discussed or missed it.
Wise RO!
Using SpaceOAR has no connection with the number of positive cores. It's just supposed to protect the rectum regardless of the amount of cancer. My urologist told me it's a money thing which I figured out later on. I had it done but after I saw the radiation machine rotating 360 degrees around my body, I realized that it was not protecting me for about 80% of the rotation. If your insurance pays for it, go for it. I can tell you that I have some rectal damage even with it.
Please see my profile for details on my situation. I had both HDR Brachytherapy and EBRT without Space Oar my RO was not a huge fan especially in high volume Prostate cancer. My Prostate was also small without a lot of BPH. I am almost two years out from HDR Brachytherapy and have so far done well post-treatment. I know I have read anecdotally where space oar has entrapped or impinged on PCA near the rectum that contributed treatment failure and complications with the RT. I woud trust your RO.
my husband had SpaceOar with ultra hypo-fractionated SBRT with many positive cores at a leading facility. He is doing quite well 2.5 years later.
This is a good article ncbi.nlm.nih.gov/pmc/articl...
Thank your for posting the article, I had read the article a few days ago. Not sure if you noticed this, see excerpt from article in italics. That is what set my alert off.
Then again, the key word is "Theoretically". Many theories throughout medical history, science, etc.., then over time, they crunch the numbers and they show that it really wasn't anything to worry about. Or you get a..."see I told you I was right and you ignored me".
Due to these concerns, patients with more than 50% core positivity or radiographic ECE were excluded from the phase III rectal spacer trial . Theoretically, placing a rectal spacer in this situation might inadvertently “push” prostate cancer cells towards the rectum and beyond the area of high-dose radiotherapy, leading to higher rates of local failure.
I had SpaceOar and have had no rectal damage that I’m aware. I see no correlation between extent of cancer and the use if it so I would question my radonc on that aspect. It doesn’t matter that the RT machine rotates around your body. The radiation beam is contoured to the prostate profile as it sees the profile as it rotates ( think of the shadow outline from a light beam) but it’s not perfect. When the radiation head is to the side of the body the SpaceOar provides separation between the prostate and rectal wall so the slight bleed-over doesn’t radiate the rectal wall. The whole reason RT works is because the prostate is radiated during the entire rotation while the tissue in front and behind the prostate are only radiated in passing. To visualize, draw multiple lines through a circle that intersect at a single point at or near the center. I know this because I asked the physicist that programmed the machine.
I was under the impression that SpaceOar should always be used when being fried.....
Heave Ho!
Good Luck, Good Health and Good Humor.
j-o-h-n Wednesday 05/24/2023 5:58 PM DST
The debate on whether Space OAR is simply a moneymaker or not is ongoing...
I can add that my rad oncologist (SBRT + IMRT for me) is now using it. When I was irradiated (fried according to j-o-h-n), the technology didn't exist.
I can't remember the name of it but there's a website where you can see which doctors and how much they get paid for using certain medications or procedures. As an example, I was diagnosed in 2017 with an autoimmune disease. Part of the treatment was infusions of a very expensive medicine called Rituximab which kills off most of your white blood cells and leaves you prone to infection. For years, once a patient was in remission, there was no need to keep treating actively. A few years ago, the world of Rheumatology decided that patients in remission should get this Rituximab every 6 months "just to be safe". I call BS on this one. My Nephrologist manages my disease and he said, why would I give you a medicine that kills your immune system when you don't need it. He even went as far as to say that these Rheumatologists do it for the money. I think it's the same case with the SpaceOAR.
I had proton beam therapy in February-April of this year. I asked about SpaceOar, but was told that due to the particulars of my case (some extracapsular involvement, including lymph nodes), they would employ a rectal balloon instead. Now I will say that having a balloon placed before every treatment and simulation (about 50 times in my case) was certainly not pleasant, I'm now about 7 weeks out from the end of treatment with no rectal side effects whatsoever. I realize there could be delayed effects down the road, but at this point I'm quite happy with the choices my doctors made (both the proton and the balloons).
I had SpaceOar lasy year done before MRI-linac (Viewray MRIdian). No ECE or +50 cores (3+4) (70 years old)The ultrasound technician was the the most competent medical person I have ever come in contact with. He could have done the whole thing without the doctor. A representative of SpaceOar also was in the room viewing the procedure. I'm only nine months out so too early to tell. I had slight BPH in Transition zone which is the area directly around the urethra so I'm having issues there at the moment and in initial stages of treatment/decisions. I wish I had taken care of that before RT but it wasn't that bothersome. I have overactive sex drive so Flo max not affecting erections. Just got back from ER after so unbelievable bloody urination, I would show a picture but why ruin your day? 2 days later and feeling much better.
Thank you for the response. Have seen some, and unfortunately smelled, some pretty gruesome stuff in my life, so bloody urine won't ruin my day. Good to hear you have cleared that up.
It wasn’t the number of positive cores that seemed to matter but location. If any of targeted cancer was very posterior and might be pushed back away from radiation treatment by Spacer it would not be used
Gleason 4+5 10/12 cores 10-95%
Thinking of Active Surveillance with 3+4
Pathology changed with 2nd opinion - your thoughts appreciated.
I'm new here. I've been diagnosed with prostate cancer.
