Rectal Spacers May Ease Radiation Side Effects
- A rectal spacer is a gel that doctors inject between the prostate and rectum before radiation therapy to specifically target and reduce side effects of the treatment such as bladder leakage and rectal bleeding.
- A rectal spacer gradually dissolves over several months and passes out of your body through urine.
- During the rectal spacer procedure, doctors often place fiducial markers, which are tiny, identifiable objects, to guide and improve the accuracy of radiation treatment.
- If you’re considering rectal spacer placement, talk to your doctor to understand the benefits and risks. Rectal spacer can minimize the amount of radiation to other parts of the body. Possible side effects include discomfort and minor bleeding but serious complications are rare.
Doctors may recommend the use of a rectal spacer for intermediate and high-risk stages of localized prostate cancer that require radiation therapy to help decrease treatment side effects such as bowel and urinary problems.
This minimally invasive procedure involves placing a special gel to create more physical distance between the prostate and the rectum.
Read MoreWhat exactly is a rectal spacer?
Your prostate is a walnut-sized gland that is situated below your bladder, directly in front of your rectum. It surrounds your urethra, where urine drains from your bladder. The prostate helps to create fluid that is added to your semen.
If you are having radiation as part of your prostate cancer treatment, your doctor may recommend having a rectal spacer injected between your prostate and rectum. Primarily made of water, this is temporary and absorbable gel that will dissolve over several months as it is passed out of the body through your urine.
There are two types of rectal spacers, SpaceOAR Hydrogel and Barrigel. Each type is made of a different material and placed in different way. Your doctor will pick the one that works best for your body and the specific treatment you need.
How does a rectal spacer work?
Advancements in radiation therapy for prostate cancer have allowed treatment to become much more precise. However, because the rectum is directly behind the prostate, this means it may be exposed to high doses of radiation. This can result in changes to normal bowel functions during and after treatment. A rectal spacer helps to create additional space between the prostate and rectum.
“So by putting in the spacer, the goal is to reduce the radiation that the rectum gets exposed to and that radiation to the rectum can cause side effects, albeit rare, such as diarrhea,” Dr. Matthew Rettig, a medical oncologist with the Veterans Health Administration in Los Angeles told SurvivorNet. “So by putting in that spacer, there’s the potential to reduce the complications related to radiation to the rectum.”
Studies suggest that patients who receive rectal spacer placement as part of their radiation treatment for prostate cancer have fewer bowel problems and improved quality of life compared to patients that do not. Studies have also demonstrated that rectal spacers improve urinary and sexual quality of life as well.
How is a rectal spacer used?
Rectal spacer placement is a simple procedure that usually doesn’t require an overnight stay in the hospital. It is typically performed by a urologist or radiation oncologist. Your doctor may give you anesthesia or a mildly sedative beforehand to help you relax.
Your doctor uses a thin needle guided by ultrasound to place the rectal spacer gel. Usually they will make three small fiducial markers in the prostate at the same time. These are small, metal objects (about the size of a grain of rice) implanted into the prostate that allow the targeted radiation to be more precise.
Typically, the rectal spacer and fiducial markers are placed one week prior to the start of your radiation planning and treatment.
The gel remains for several months. Your body gradually reabsorbs the rectal spacer and eliminates it through urine, ensuring your radiation treatment is complete before this happens.
How can rectal spacers help?
Depending on the stage (or risk group) of your prostate cancer, overall health, and treatment goals, your care team will recommend different treatment options. These may include:
- Active surveillance (or a watch and wait approach)
- Radiation
- Surgery
- Hormone Therapy
- Chemotherapy
If you and your healthcare team have decided on radiation therapy, rectal spacers can help reduce the side effects, including problems with bowel movements and urination.
Discuss the pros and cons of a rectal spacer with your doctor if you are undergoing radiation treatment for prostate cancer.
Possible complications
Rectal spacer placement is relatively easy and safe with a low risk of complications. However, the side effects that do occur may include:
- Pain or discomfort associated with the rectal spacer injection
- Injection of the gel into the bladder, rectum, prostate, or urethra
- Infection
- Urinary retention
- Ulcers
- Necrosis (cell tissue death)
- Bleeding
- Change in bowel habits with either urgency or constipation
Tell your healthcare team about any symptoms or side effects following rectal spacer placement.
In addition, prior to receiving a rectal spacer it is important to give your doctor a complete medical history including:
- Use of a blood thinner, steroids, or antibiotics
- Allergies to medications or latex
- History of heart disease
- History of prior infections or hospitalizations from prior treatment
Rectal spacer is an exciting new technology that can significantly reduce the side effects that come with treating your prostate cancer with targeted, high-dose radiation. Have a discussion with your healthcare provider if you feel you are a candidate for rectal spacer or would simply like to know more.
Prostate Cancer Overview
Prostate cancer, the most common non-skin cancer in men and the second leading cause of cancer-related deaths, can be a challenging diagnosis. While it’s a serious disease, most men with prostate cancer live long lives; over 3 million diagnosed men in the U.S. are living proof. Veterans can get specialized care and support through the VA healthcare system, enhancing their treatment and chances of survival.
The behavior of the disease can vary significantly from person to person. Prostate cancer often presents without any symptoms. Sometimes men will have urinary symptoms, and less commonly it can present as metastatic disease, which means it has spread to other parts of the body beyond the prostate.
Your doctor will use some common tests to diagnose prostate cancer:
- PSA (Prostate-Specific Antigen) blood test
- Prostate biopsy
- Imaging with MRI , CT, or bone scans
- Molecular biomarker testing
Many men don’t have any symptoms before being diagnosed. They only find out when their PSA blood test returns with an abnormal result. Besides the PSA blood test, doctors may perform a biopsy, which involves removing a small sample of tissue to test for the presence of cancer. Your doctor may order additional testing depending on your initial test results and your overall risk.
As for treatment, it depends on the stage of the disease. Regular monitoring ensures the best approach at every stage. If the cancer is more advanced, your doctor may recommend surgery or radiation. They may also consider hormone therapy to help slow its growth. In some cases, doctors use chemotherapy, especially if the cancer has spread to other parts of the body. Because you are getting care through the VA, you are likely to have access to the most up to date treatments available.
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