I knew going in that the data on the SpaceOAR didn't strongly endorse the spacer. My particular RO would not do Cyberknife treatments without it, and they have had good experiences with minimal-to-no post-treatment side effects using the gel. My insurance company would not pay for it and deemed it "experimental." Curiously, it is covered by Medicare, but I'm not eligible yet. Both my URO and I have appealed the denial without success. Ultimately, I decided that it might be best to have it in case it is determined later that it prevents long term side effects.
I talked to my RO about
the use of the endorectal balloon you mentioned. I was told that "they tried to get us to use that in the past." (I don't know who "they" is) Their data suggested that the ballon would flatten out the rectum and actually increase the amount of surface area subjected to the higher dose of radiation. He insists on using the spacer as a separating barrier between the prostate and rectum, especially with the high-dose fractions of SBRT.
I think my URO was a little surprised that I chose radiation over surgery. Every case is different and for me it seemed that lower-level disease contained in the organ seems to respond extremely well to radiation. I've read that the healthier you are going into surgery, the better your recovery will be. It's possible that my recuperation from surgery might have resulted in the "trifecta." My second opinion URO at Duke was too quick to jump straight to surgery without nerve sparing on one side, and I found that unsettling. Given the immediate side effects following surgery, the risk vs. reward never made sense for me.
I had my three-week followup appointment with the RO yesterday. Again, the whole event has been unremarkable for me also. All body parts functioning normally. I'll see him again the first week in December for my first PSA and a finger wave to check on the absorption of the SpaceOAR gel. I follow Allen Edel's site and am mentally preparing for the bounce, if it occurs. Another interesting tidbit of information I've read in the past and heard from my RO again, is that men on statins over the long term seem to respond well to radiation treatment of the prostate. There's no understanding yet of why that might be the case.
Thanks for the well wishes. Best of luck to you too!
64 y.o. at Dx. BMI <25, 3/15/19 PSA 4.9, 4/25/19 3TMRI showing PIRADS 4 lesion, remainder of MRI negative, 5/14/19 MRI fusion biopsy showing Gleason 7 (3+4) favorable/intermediate, T2A,NX,MX, but MRI clear.
Multiple consults with local URO/RO
2nd opinion with Duke.
Oncotype testing: GPS 37
2nd opinion biopsy at JH: downgraded.
Fiducials/Space Oar early Aug 2019
SBRT x5 during Aug 2019
Post Edited (e.noont) : 9/18/2019 1:16:00 PM (GMT-6)