SpaceOAR Hydrogel reduces side effects of radiation therapy for prostate cancer patients

Thanks to a newly FDA-approved product, prostate cancer patients can experience less side effects of radiation treatment. Called SpaceOAR Hydrogel, the Nancy N. and J.C. Lewis Cancer & Research Pavilion is the only facility in the region to regularly offer the product.

Dr. John Schuler
Dr. John Schuler, radiation oncologist at the LCRP

SpaceOAR Hydrogel acts to provide space between the rectum and the prostate, making it less likely that the rectum is exposed to radiation. Think of SpaceOAR similar to that of a filler a plastic surgeon or dermatologist would use for a cheek augmentation, describes Dr. John Schuler, radiation oncologist at the LCRP.

“The theory behind SpaceOAR is if we could create some separation between the two it would minimize the amount of radiation that goes to the rectum and thereby decreasing the side effects,” Dr. Schuler says. “By injecting SpaceOAR Hydrogel and creating that space, you can give a really high dose to that prostate over a shorter period of time without creating excess side effects.”

The SpaceOAR Hydrogel procedure is performed in the operating room under light anesthesia. The gel is placed under ultrasound guidance through a needle that goes into the skin of the perineum, which is located between the scrotum and anus. The gel is injected and creates spacing.

SpaceOAR is injected into place prior to the start of radiation treatment. Because most prostate cancer patients have markers put in place for visualization to locate the prostate, patients may opt to have SpaceOAR hydrogel injected at the same time. It’s not painful, remains stable during radiation therapy and then is gradually absorbed by the body after radiation therapy is complete.

Prostate cancer treatment options

Prostate cancer is one of the most common cancers treated at the LCRP, along with breast and lung cancers. Prostate cancer treatment has a high success rate in terms of curing most patients with localized prostate cancer, Dr. Schuler says. The goal now is to improve technology to minimize side effects and decrease length of treatment.

Prostate cancer patients have several treatment options that can include radiation, surgery or a combination, with radiation following surgery. The length of radiation treatment also is up to the patient with guidance from the radiation oncologist.

Before technologies like CyberKnife and TrueBeam radiation therapies, treatments were less precise and had to be spread out over a longer period of time to reduce injury to normal tissue, Dr. Schuler says. The standard regiment historically was about 45 radiation treatments over the course of nine weeks.

Thanks to advances in technology, there’s been a drastic shortening of the treatment course. A patient who opts for therapy using the TrueBeam device – which delivers a more precise radiation beam and keeps exposure to healthy cells to a minimum – requires only about four to five weeks, or 20 to 25 treatments, of radiation therapy. Those that opt for CyberKnife – which delivers high doses of radiation to small areas with phenomenal accuracy – have an even shorter course of treatment with only five sessions typically needed.

Related Article: Lifelong law enforcement agent becomes first prostate cancer patient to be treated with CyberKnife

“The longer course is a little bit gentler biologically speaking but with modern technologies and something like SpaceOAR, we think it’s equivalent to treating in the shorter course,” Dr. Schuler says.

Side effects and SpaceOAR success

The most common side effect of radiation treatment for prostate cancer is bowel irritation, meaning loose, more frequent bowel movements, perhaps diarrhea in some cases, Dr. Schuler says. Other, less common side effects may include urinary incontinence, rectal bleeding and changes in bowel habits such as persistent urgency of bowel movements.

SpaceOAR Hydrogel was clinically tested in the United States and Europe. Results showed the space created by the hydrogel significantly reduced the radiation delivered to the rectum. The U.S. clinical trial found that patients who received hydrogel spacer reported significantly less rectal pain during radiation therapy and had significantly less severe long-term rectal complications.

Additionally, the side effects to the actual SpaceOAR implantation are very minimal, Dr. Schuler says.  

“SpaceOAR is an option for each type of radiation treatment for prostate cancer patients,” Dr. Schuler says. “We consider it almost mandatory for CyberKnife patients because of the really high dose the rectum is getting. For patients that want to be treated over four or five weeks, I tell them I prefer if they have it for that too. For the nine week treatment, it’s not mandatory because we’ve been treating men like that for a long time without many problems. If they really want to do everything in their power to minimize side effects, I tell them SpaceOAR is an option.”

David Nelson
David Nelson

Patient success story

David Nelson learned about SpaceOAR when the 71-year-old Hilton Head resident was exploring options to treat his cancer in 2017. He was not a candidate for surgery because of a prior condition, so Nelson opted for radiation therapy using TrueBeam with SpaceOAR Hydrogel.

Nelson was a patient at the Medical University of South Carolina in Charleston where his physician there told him about SpaceOAR. Nelson also met Dr. Schuler at MUSC, who was completing his residency. When Dr. Schuler joined the team at the Lewis Cancer & Research Pavilion in both Savannah and Hilton Head, Nelson followed.

“When I learned Dr. Schuler had years of experience, I decided to follow him (to the LCRP),” Nelson says. “It was local and a lot closer. Since I had to have treatment every day, I would have had to move or live in Charleston during the course of my treatment. Since I could do this in Hilton Head, it didn’t disrupt my daily routine.”

Nelson had SpaceOAR Hydrogel placed while he was under anesthesia prior to the start of his radiation treatment. He said it was not painful, and he didn’t have any complications from the procedure.

Nelson then had 20 treatments of TrueBeam radiation therapy. He describes it as very quick – as long as he had a full bladder, he was in and out in about 10 minutes. Nelson also said he had very minimal side effects. He only recalls a couple of days he had to think about his normal routine.

“Having gone through it, I have a lot of confidence in the entire team from Dr. Schuler to the radiation team to the urologist,” Nelson says. “Everybody treated me with respect and professionally. I couldn’t have asked for better care.”

For more information about the Nancy N. and J.C. Lewis Cancer & Research Pavilion, visit our website

Related Article: Five things men should know about a prostate exam 

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