Men undergoing radiation therapy for prostate cancer now have an option to minimize the troubling side effects that often accompany treatment.
Baystate Medical Center, through its Baystate Regional Cancer Program, is the only hospital in western Massachusetts to offer SpaceOAR Hydrogel to its prostate cancer patients. The absorbable hydrogel – created by Boston Scientific – temporarily creates space between the prostate and the rectum, reducing the radiation dose delivered to the rectum during prostate radiation therapy.
A Game Changer
“Today we can target tumors in the prostate and elsewhere in the body with greater precision than ever before, sparing surrounding normal tissue. However, radiating the prostate presents a greater challenge because the rectum sits so close to the prostate,” said Dr. Michael Yunes, the chief of radiation oncology at the Baystate Regional Cancer Program.
By acting as a spacer, the SpaceOAR Hydrogel pushes the rectum a ½ inch or more away from the prostate. It allows for better targeting of radiation treatment while preserving healthy tissue and minimizing side effects such as rectal pain and bleeding, diarrhea, urinary symptoms, and even reduces erectile dysfunction. It is available for use at Baystate for many patients when receiving external beam radiation therapy.
“Our ability to add space between the rectum and the prostate is a real game changer. We can essentially reduce the rectal side effects of radiation to almost zero. It is truly amazing to see how much of a difference this added space makes in the dose to the rectum which is clinically significant. Patients are happier and have a much easier experience,” said Dr. Yunes.
Approved by the Food and Drug Administration (FDA), SpaceOAR Hdrogen is made of two liquids that when combined form a soft gel material that is mostly made of water. Because of the water content it is called a hydrogel. It can be safely used in the body without causing injury or a reaction. It stays in place, separating the prostate and rectum for about 3 months, then after 6 months the hydrogel is naturally absorbed into the body without any side effects and then removed in the urine.
At Baystate, the outpatient procedure is performed by interventional radiologists and takes approximately two hours. Doctors use local, regional, or general anesthesia and the injection site will be numbed before SpaceOAR Hydrogel is injected as liquid through a small needle inserted between the rectum and the prostate. At the same procedure, before the gel is inserted, three gold seeds are placed in the prostate to help guide the radiation treatments as accurately as possible.
“I am very honest with my patients. I explain that the benefit is so large, that if I or anyone in my family were to have a new diagnosis of prostate cancer, I would not want them treated with radiation without SpaceOAR. Not all patients are candidates, therefore, a clear discussion is required with your radiation oncologist and urologist before considering this option,” said Dr. Yunes.
In a three-year follow-up study conducted by Boston Scientific, patients were asked to report on their quality of life for bowel, urinary and sexual functions. These patient-reported outcomes show that SpaceOAR Hydrogel patients experienced significantly fewer long-term rectal side effects, were more likely to maintain sexual function, and showed significantly reduced decline in patient-reported urinary and bowel quality of life.
Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the United States. This year some 174,650 new cases of prostate cancer will be diagnosed, and 31,620 men will die from the disease. According to the Prostate Cancer Foundation, 1 in 9 men will be diagnosed with prostate cancer in his lifetime. Risk factors include age, especially for men over 50, and a family history of prostate cancer. African-American men and Caribbean men of African descent are at greater risk for prostate cancer.
Early prostate cancer usually results in no symptoms until the cancer has advanced and may cause:
- Problems urinating, blood in urine or semen
- Erectile dysfunction
- Bone pain
- Pain in the lower back, pelvic area, hips or thighs.
While early detection is key in most cancers, there is limited evidence that screening all men for prostate cancer yields reductions in prostate cancer deaths. Types of screening include a digital rectal exam (DRE) or prostate-specific antigen (PSA) blood test. All men should discuss with their primary care provider whether prostate cancer screening is appropriate and worthwhile for them.
The main treatment options for prostate cancer patients today include close monitoring of the cancer and treating it at the time of progression or when it causes symptoms, surgery called a prostatectomy to remove the prostate, and radiation therapy using various techniques.
The five-year survival rate for localized prostate cancer that has not spread outside the prostate is nearly 100%. For those cancers that have spread outside the prostate, such as the lung, liver or bones, it is 30%.
“At the Baystate Regional Cancer Program, we discuss all options with our patients. However, we endorse and offer the most common radiation treatment approaches which include external beam radiation therapy with either standard fractionation with eight weeks of daily treatment, or the new hypo-fractionated radiation therapy treatment of five-and-a-half weeks of daily treatment. We are investigating other alternatives as they arise,” said Yunes.