Brachytherapy and new protective gel?

I doubt it's worth the cost for most men. It doesn't improve acute rectal side effects (which many men will have), only late-term rectal side effects (which few men will have). Here's what I found:

/pcnrv.blogspot.com/2017/01/spaceoar-hydrogel-is-difference.html

Interesting, Allen. I have always felt as you do. Last night I saw the presentation on SpaceOAR, presented by an RO from a very large urology practice. The reps from Augmenix were there, too. Their position is that a sizeable percentage of radiation patients (something like 15-20%) experience significant rectal toxicity. That is in opposition to the study results we've seen on treatment modalities like SBRT of late.

I did not speak out, as I didn't want to cause a scene, but if any of the men in the audience were newly diagnosed, I'll bet that they are being sold a product that has less benefit than the pitch claims.

Personally, after my SBRT treatment, I do have some rectal issues. No bleeding, but occasional urgency. Not a life-altering situation, and I am watching to see if it gets better or worse. Of course, I also must admit to having had IBS for many years prior to treatment, so there may be a connection there as well. In other words, my case most certainly will not be like those of most other patients.

They don't claim any improvement in acute (<3 month) symptoms, but only in late-term (>6 month) symptoms, at least not grade 2 or higher. As of 3 years post-treatmen, grade 2 or higher rectal adverse events had occurred in only 6% of patients (only 1 patient had a grade 3 (serious) event) all in the control group. Now, in Dr. Katz's 7-year QOL study (in my signature), he reported that 4.5% of SBRT patients who received 36.25 Gy of SBRT had experienced a late-term rectal event.

These are very small numbers of patients who come down with late-term rectal events, mostly not serious. So is it worth treating every man to benefit those few? I think that it has a role, but better patient selection is needed. Patients can be selected who have had a history of bowel problems, or anatomic abnormalities that may make it difficult to meet rectal dose constraints. I think that setting and adhering to tight rectal dose constraints is a much better solution.

browntrout said...
Stray: My (first) urn surgeon scared my as well......
I seriously doubt that an RO would give you the same story. Experts "in their field" is exactly that, "their field".

Which doesn’t excuse the ignorant, self serving, wrong advise too many of them offer up.

Caveat Emptor, my brothers!

Stray said...
My husband is so focused on minimizing risk of impotence, but I think the incontinence and bowel issues would be as difficult.

I thought the same way. That's why I chose SBRT - it and HDR brachy had the highest reported potency preservation, around 70-80% - probably even higher at his young age. Incontinence is almost never an issue after radiation, but there may be urgency for a while.

This is very encouraging. Thank you all for the info!