Hydrogel - SpaceOAR® (Organ At Risk) Technology

[Nev Black]

[A couple of weeks ago we had a conversation about Hydrogel, and thank you all for your response. A study to evaluate the benefits of Hydrogel with image-guided intensity modulated prostate radiotherapy (IG-IMRT) is below. Some men, with a prostate, about to have radiotherapy of the prostate, may find this interesting. The article was published in Oncology Weekly, Tuesday 5 December 2017. After reading the information please go to the link at the bottom of the page. This link may give a clearer idea how Hydrogel can help. Nev]

 

Absorbable Hydrogel Spacer Use in Prostate Radiotherapy: A Comprehensive Review of Phase 3 Clinical Trial Published Data.

November 28, 2017

Objectives
To provide an update on SpaceOAR® System, a FDA approved hydrogel indicated to create distance between the prostate and rectum which has been studied in phase 2 and 3 clinical trials. Here we review and summarize these clinical results including: the safety of prostate-rectum spacer application technique, the implant quality and resulting rectal dose reduction, acute and long term rectal, urinary and sexual toxicity as well as patient reported outcomes.
Methods
A prospective, randomized patient-blinded clinical study was performed comparing image-guided intensity modulated prostate radiotherapy (IG-IMRT) (79.2Gy in 44 fractions) in men with or without prostate-rectum hydrogel spacer. Patients were followed for 3 years, allowing for assessment of long-term safety and efficacy.
Results
Spacer application was well tolerated with a 99% technical success rate. The mean additional space created between the prostate and rectum was just over 1cm which allowed for significant rectum and penile bulb radiation dose reduction, resulting in less acute pain, lower rates of late rectal toxicity, and improved bowel and urinary QOL scores from 6 months onward. Improvements in sexual QOL were also observed at 37-months in baseline-potent men, with 37.5% of Control and 66.7% of Spacer men capable of “erections sufficient for intercourse”.
Conclusions
Prostate-rectum hydrogel spacer application is a relatively safe technical procedure which is well tolerated and has a high technical success rate. Spacer application significantly reduces rectal radiation dose, and results in long-term reductions in rectal toxicity as well as improvements in bowel, urinary and sexual QOL

Urology. 2017 Nov 23. pii: S0090-4295(17)31213-X. doi: 10.1016/j.urology.2017.11.016
Author Information

Lawrence Karsh¹, MD, Eric Gross ¹, Christopher M. Pieczonka², Philip J. Aliotta³, Christopher J. Skomra ³, Lee E. Ponsky⁴, Peter T. Nieh⁵, Misop Han⁶, Daniel A. Hamstra⁷, Neal D. Shore^8
1 The Urology Center of Colorado, Denver, Colorado.
² Associated Medical Professionals of NY PLLC, Syracuse, New York.
³ Western New York Urology Associates, Cheektowaga, New York.
⁴University Hospitals Case Medical Center, Cleveland, Ohio.
⁵ Emory University, Atlanta, Georgia.
⁶ The Johns Hopkins University, Baltimore, Maryland.
⁷The Department of Radiation Oncology, Beaumont Hospital, Dearborn, MI.
⁸ Carolina Urologic Research Center, Myrtle Beach, South Carolina.  

 

[This link below may take a few seconds to load if you have to copy and paste. The item was published in Oncology Daily, 5 December 2017. It may give a clearer picture of hydrogel is used. Nev]

 

https://www.urotoday.com/beyond-the-abstracts/urologic-oncology/prostate-cancer/100511-absorbable-hydrogel-spacer-use-in-prostate-radiotherapy-review-of-phase-3-clinical-trial-published-data-beyond-the-abstract.html

[Patrick Turner]

1 hour ago, Nev Black said:

Improvements in sexual QOL were also observed

And we must wonder at the inventiveness of doctor-speak when we consider what was said about radiation effects on erectile matters.

I had the gel before getting 31 grey to PG with IMRT with Calypso at Epworth some 16 months ago. I'd already been fried up a bit with 70Gy at Canberra Hospital in 2010. The doc at Epworth said I sure will not have any erection after I have the extra 31Gy. But I still get erections I do not want. After the 2010 EBRT primary treatment of PG, I began to wane sexually after 4 years because of RT and the ADT. In 2015, Roger had shrunk permanently, filled with fibroids, so the hard is like a 90 degree bend towards feet. All the pleasure sensations had vanished by 2014. Desire has not vanished, and I often have dreams about which I cannot type, and Desire takes the form of wanting female companionship, and afaiac, that seems impossible. Roger became not only a shadow of his former self, but fragile, because without testosterone, there's a whole pile of things that just quit. But I am fully continent, despite my nerves around PG being fried with total of 101Gy. So how much RT went to "penile bulb" or other bits and pieces? 

At 70, I find I have lived in a world for past 30 years of almost zero females interested in sex. So sexuality after 40 wasn't necessary at all, and I am not an addictive person, and I was never addicted to grog, smokes, gambling, sex-workers or to my own Dick,  so when I found myself to be completely sexually mutilated by prostate cancer treatments in 2015, did I care? The urologist suggested a vacuum pump, but failed to explain to me the inevitability of penile damage due to prolonged ADT. So, just suck it up bro. I can't understand why everyone says sex is so important. Sure it feels good when its had, but there comes a time its more trouble than its worth, and neither you or her can operate as an erotic being able to get high on the hormones generated by love and sex. But the focus on sex is money related in our consumeristic dollocracy. 

 

I occasionally visit a Chinese girl of about 52 who does brilliant body massages when bits of me get sore from cycling, something that happens more often now because of bloomin Zytiga. A "happy ending" is not possible, or wanted, and what this lady does to me is just wonderful, she knows where I ache, how to rub it, and I feel better. 30 years ago, I used to massage the ladies I won; oh how they liked it, and there was a happy ending often, the Full Wonder Treatment, but not one of any of the ladies I courted could ever massage me like the one I am currently seeing.

 

It seems to me the nature of sex requires men lead graciously, and as Bettina Arndt said, "once you get her into the canoe, and she's not afraid, she might paddle a bit and enjoy herself." This is something my father never could teach me. Methinks getting women willing is now an impossibility, irrelevant, and I doubt ANY woman I should be with, say someone 60, is ever going to feel comfortable anywhere near a canoe, or near me, so I've given up on ladies being around for us, ie, not just for her sake, but for happiness of both of us. Bettina got a lot of things wrong in her books, which are written to appeal, and principally to get a quid, IMHO. At 70, a man might lead himself astray by thinking she ought to like a bit of a travel on a 70 Meter canoe where too much food is served and cost is $3,000 a day.

 

There must be a HUGE percentage of men who have sexual dysfunction by 60 or sooner, and Pca is just one of those things among many which so often leads to extermination of sexual function. Beneath the veneers of appearances, so many ppl have rather poor sex lives and I've seen women give up sex interest by 25. A very few last until 50, and by 70, they are very rare, but its all natural, as Nature demands of us; women need to become non sexual so they can become good grandmothers to look after the grand kids while their own kids are on the hunt or on the gather for money. Sex is so much more than just a technical issue of getting a hard on or not. 

I doubt I am the only one who gets unwanted erections. But of course involuntary erections were designed in by Nature who figured that if a fellow woke up at 25 with a hard on, and he's with a wife, its going to make gene propagation all the more likely and less dependent on modern airy-fairy notions of foreplay taking hours etc. By 70, and with muddled nerves, stuffed up this and that, you get weird things happening, most uncool. So suck it up bro.  

 

The standard EBRT with x-rays in 4 directions to PG is limited to 70Gy lest it do too much damage to rectum. 67% of men having standard EBRT bleed from rectum within about 18 months, and it may continue for months, and be occasional, or severe, but mostly its when you pass solids, when the rectum is stretched, which ruptures radiation affected tiny arteries. My rectal bleeds became less common after a year. When I had the second "salvation" IMRT at Epworth in 2016, there were no immediate side effects of feeling burnt, but a month after the last RT sessions I had very bad bowel colitis for 2 months, but no bleeds. I am now quite faecally and urinly continent, although I MUST go when I feel I want to, unlike being 30, when we always say NO, because we are in the middle of doing something, and bowels and bladder just have to wait. But no more Shit In Pantz Events. And NO bleeding, so probably the gel worked well, and it should be used for ALL beam radiation to PG, because there are some fellows I have known who bled a lot more than I did, and if you search online chat groups you'll find some ppl who have terrible on-going bleeding problems after pelvic radiation. 

What I do know is that thousands of men and women have far greater problems than I do.   

I'm continuing to cycle into summer, I am doing ENOUGH to stay fit, and hopefully sane, despite the slight problem of Puff The Magic Prostate Grenade slowly exploding. 

Patrick Turner.