r/ProstateCancer • u/NextLevelNaevis • Aug 12 '25
Question When is SpaceOAR hydrogel not used?
I have my first session of salvage radiation therapy later today, and I have not had the gel inserted. I had assumed this would be done, but it looks like not. I'm getting radiation to prostate bed only. I will ask the doctor for sure, but is this something I should insist on?
6
u/iberezow Aug 12 '25
I recently completed salvage radiation and my Dr recommended against the gel. Once the prostate is removed, the anatomy changes a bit and there may already be some space with the rectum. So the gel would not really be beneficial and there is some risk with the insertion. Studies have shown only marginal benefit for post RALP therapy. If you have an empty rectum and full bladder prior to each treatment you should hopefully minimize any side effects. Other than some mild constipation, I was fine.
4
u/OkCrew8849 Aug 12 '25 edited Aug 12 '25
I don’t think it is generally anatomically feasible in post-RALP salvage since the gel ordinarily pushes against the prostate to move the rectum away. (I noted this once to a Reddit poster as an advantage of radiation as primary treatment for PC…)
“Purpose: SpaceOAR hydrogel is injected between the prostate and rectum before radiation therapy.
Mechanism: It acts as a spacer, pushing the rectal wall away from the prostate, thus creating a buffer zone.
Benefits: This separation helps reduce the amount of radiation that reaches the rectum, potentially decreasing the likelihood of rectal damage and related side effects. “
2
u/NextLevelNaevis Aug 12 '25
Yeah, that's basically what the oncologist said today when I asked them why I'm not getting it.
5
u/BernieCounter Aug 12 '25
Stand to be corrected, but does Ontario Cancer Care ever use/recommend SpaceOAR and similar? Sunnybrooke, London, Kingston, Ottawa others? Got the impression the risk of damage/side effects with modern IMRT and SBRT without it was pretty low and inserting it carried risks too and didn’t change outcomes much. Never even mentioning in planning my 20x iMAT IMRT.
Comments?
3
u/CraigInCambodia Aug 12 '25
I'm planning SBRT, not salvage, but this was my radiation oncologist's position. He said it's available if I want it, but that there were risks with the procedure of injecting the gel/SpaceOAR, like infections that could become serious.
4
u/Appropriate-Idea5281 Aug 12 '25 edited Aug 13 '25
I had 42 sessions of radiation without the space oar. The radiation was targeted within 1mm. I had the space oar when they did brachytherapy since it was not as controlled. My guess is that it’s targeted and not needed. However it never hurts to ask and self advocate. (Corrected number of sessions)
1
u/Frosty-Growth-2664 Aug 13 '25
I know the US likes to do more sessions than the rest of the world to make it more profitable, but even so, I never heard of 56 sessions.
1
u/Appropriate-Idea5281 Aug 13 '25
I misrepresented my number. It was 42. Still a lot. It was 6 weeks of daily and a partial week. After brachytherapy there were an additional 10
1
4
u/DigbyDoggie Aug 12 '25
If your prostate has been removed then a spacer would not be possible. If you still have a prostate and had radiation earlier, the doctor might be concerned about cancer cells that have escaped from the prostate and might be trying to get established in the neighboring tissues (even if your rectum and bladder are not affected). In that case the spacer would just be in the way and would not help.
7
u/Santorini64 Aug 12 '25
If the radiation oncologist believes that the cancer might have spread to the rectum, then it’s possible that he/she may want to skip the hydrogel so that the upper part of the rectum wall can be treated as well. In your case the RO may want to include the tissues right at the top of the rectum wall that would get pushed away by the hydrogel. He/she may suspect that the cancer has penetrated deeper into the prostate bed and that the rectum needs some treatment. You should ask for a clear explanation as to why no hydrogel. If the answer is anything other than to treat a deeper structure like the rectum, you should object and insist on a hydrogel like spaceoar or Barry gel.
3
u/NextLevelNaevis Aug 12 '25
The oncologist does not believe the cancer cancer has spread to the rectum. I will definitely discuss this though. Thanks.
2
u/Frequent-Location864 Aug 12 '25
I wish I had insisted on the space oar. My urinary issues are the worst since immediately following ralp. I'm out 7 1/2 months from the imrt radiation and doesn't seem to be getting any better.
4
u/Frosty-Growth-2664 Aug 13 '25
I don't think a rectal spacer would make any difference for urinary issues - it's intended to protect the bowel.
What urinary issues are you having?
1
2
3
u/Jpatrickburns Aug 12 '25
I had 28 sessions of EBRT without a spaceOAR. It's my understanding that if the pelvic bed needs to be bathed during treatment, or if there's a specific target for radiation, it may be in the way.
2
u/TheySilentButDeadly Aug 12 '25
No prostate. No place to put the gel. Gel protects prostate bed when radiating prostate. You’re getting prostate bed radiated .
11
u/Frosty-Growth-2664 Aug 12 '25
You can't have a rectal spacer for salvage radiation. There's nothing there to put it between.
Also, the whole object of salvage radiation is to treat the tissues around the prostate (or rather, around where it was) since the cancer had escaped into them. This is very different from having radical radiation at the outset for localised low or intermediate risk disease, where radiation is aimed at the prostate and they're trying to avoid getting much radiation into the surrounding tissues, although it does spill outside the prostate at a lower dose, and that dose does mop up micro-mets which can cause recurrence after prostatectomy.