August 1, 2022
Contributed by Dr. James Taylor, MD, MPH, Medical Fellow at SurvivorNet.
For a lot of us who treat men with prostate cancer, there are preferred methods and pathways. But, regardless, some of us in the community are not offering a simple procedure that can significantly improve quality of life for these patients.
We’re talking about something called a rectal spacer. This device could up the chance to significantly minimize the side effects of radiation.
Being a highly curable, localized disease allows treatment options to range. What most patients collect in their own research is they can supplement radiation therapy with either external beam radiation therapy or brachytherapy, surgery, active surveillance, hormonal therapy, or a combination of these treatments. Of note, active surveillance is only recommended for a very well-defined group of men with low-risk prostate cancer. In the United States, the two most common treatments for prostate cancer are surgery and radiation therapy.
Why does radiation cause rectal irritation and how can this be prevented?
The cause of rectal irritation during radiation treatment is due to the anatomy of the prostate gland which sits directly in front of the rectum. When radiation is given to the prostate gland some amount will also be given to the rectum which can potentially cause the side effects mentioned. However, thanks to a relatively new procedure that is becoming used more frequently, these side effects can be prevented. The procedure is called a rectal spacer placement and there are currently two FDA-approved products used for this procedure the SpaceOAR and Barrigel systems. These procedures are protecting men from many of the side effects from radiation therapy and are improving the quality of life if men diagnosed with prostate cancer who elect radiation treatment for management.
This small space makes a huge difference for patients.
Simply, this procedure allows for the placement of a gel to be inserted between the prostate gland and the rectum. When the gel is inserted into this space (known as Denonvilliers fascia) the prostate is pushed forward and the rectum is pushed backward creating room between these two organs. This new space is held open by the gel that is inserted during the procedure and after a while (with SpaceOAR) the body will absorb the gel and the space will return to normal.
Although this space may only be a few millimeters, using modern radiation techniques, it creates enough room to reduce the dose of radiation the rectum will receive during treatment and reduce side effects. Studies have shown that men who have this procedure before radiation have significantly fewer side effects. Dr. Michael Greenberg, MD Vice Chair of Business Development and Clinical Associate Professor at the Sidney Kimmel Cancer Center at Thomas Jefferson University says
“I feel that patients benefit dramatically from a rectal spacer placement.”
Dr. Greenberg has performed more than 1500 rectal spacer procedures in his practice and recommends them to all patients. He goes on to say, “as long is there is room for the rectal spacer to be placed it markedly improves our ability to deliver therapeutic radiation doses while minimizing dose to the rectal wall and the lower we can keep the dose to the rectum the better it is for the patients overall outcome and quality of life.”
The procedure is performed in the office and takes about thirty minutes. Similar to a prostate biopsy, you will be placed in the dorsal lithotomy position (on your back with your legs up) and an ultrasound will be placed in the rectum to visualize the prostate, bladder, rectum, and surrounding organs. Your urologist or radiation oncologist (both specialists can perform this procedure) will then use local numbing medications to ensure you are comfortable during the procedure and do not feel any pain. Once numb, a needle is inserted into the space between the rectum and the scrotum using the ultrasound for guidance. Once the space between the prostate and the rectum is reached it is dissected with saline and the gel is inserted. The needle and ultrasound are removed, and the procedure is completed. Most men only experience mild soreness and can return home after the procedure. The gel stays in place during radiation treatments and is later absorbed by the body naturally. The small space created by this procedure makes a huge difference for patients and dramatically reduces the side effects of treatment.
Although there are some contraindications (reasons not to have the procedure) most men with prostate cancer considering radiation treatment should have this procedure done. Dr. Greenberg says that: “As a radiation oncologist, this is a procedure I discuss with all my patients, as I believe it makes a big difference in reducing side effects…
… I have learned a lot from my experience with this procedure and believe this procedure has dramatically improved outcomes for patients.”