So this question comes from a patient who is considering IMRT without SpaceOAR. They have
a very experienced radiation oncologist, and the oncologist told them that there's
growing concern that with SpaceOAR when they have extra capsular extension
that he'd recommend not using SpaceOAR because that he finds that the cancer
cells can be pushed away from the needed radiation area. Do you agree with this?
Well if — thankfully, extracapsular extension posteriorly toward the rectum is
not terribly common if patients are screening with PSA regularly. So, I don't think it's occurring
frequently enough to make any policy out of it, but if a patient on MRI was shown to have
clear-cut extracapsular extension posteriorly toward the rectum, then I think it would be a
question as to whether SpaceOAR could get between the cancer and push some of the cancer cells
further away from the treatment field. Patients who are going to very experienced cancer centers,
we know the statistics of rectal burns of people that are going to these centers
from pre-SpaceOAR studies, and it's not a really high risk—maybe one to two percent risk of a
rectal burn at an experienced center without SpaceOAR. It is feasible to do it. I think that
in cases where SpaceOAR can be safely used, I would definitely use it because even though
rectal burns are rare, they're really devastating problems that can be lifelong when they occur.
Our next question is in regard to GI conditions, so gastrointestinal
conditions, they want to know if there's any studies that looked at how patients do
who have IBS syndrome, so irritable bowel syndrome, and are also receiving radiation
for their prostate. Are there any sort of studies that can talk about the effects?
I don't know about studies, but historically when patients would undergo old-fashioned pelvic lymph
node radiation there was a potential long-term damage to the intestines which manifests like
irritable bowel syndrome. That's like, unexpected diarrhea, constipation, stomach discomfort that
never goes away, and this, with modern techniques, has been greatly reduced but there's always
consideration of increased risk in people that have bowel problems like Crohn's disease or
ulcerative colitis, and historically radiation was completely avoided when people had those
pre-existing problems. Now with modern techniques, it is possible to consider radiation and it's
comes on an individual basis — How serious is the problem? How big is the radiation
field? In the old days you would never even consider radiation in these individuals,
but radiation has gotten so much better that it's now on the table for discussion in select cases.
So on our next question this person will like an overview of strictures and then also once
we go over the overview, are there urodynamic testing, are there treatments for this? You know,
first of all, I guess we should start off with, "what are strictures?"
So people that have treatment to their prostate most are aware that there's a tube that passes
from the bladder through the prostate and out the penis, and that tube is in ground zero,
for example, if you have radiation or if someone has their prostate removed they slice both ends of
the tube, at each end of the prostate, and then they sew back together again. Anytime you have
scar tissue created by an incision or by radiation there is a possibility for excess scar tissue.
Think of keloid formation; some people have seen the large bumps on people's skin after surgery;
that's excess scar formation, and scar is very difficult to handle you try and cut it out and
more scar comes back. This becomes a real issue if it starts to block off the urethra, and there's no
simple solution for this. Probably someday they'll invent some sort of a medicine that shuts down the
scarring process but we haven't invented that yet, and until then, now it's just managed,
you know, people put a catheter in and wait; they'll go in and try and gently
incise and remove a little of the scar tissue with a knife hoping it doesn't make it worse,
but this is one of the dreaded complications of both surgery and radiation and three or four
percent of people that have radical prostatectomy develop strictures, maybe one to two percent of
people that have radiation can develop strictures in their urethra, and there's no easy solution.
There are some specialists at large clinics that devote their lives to surgical correction
of removing the scar and trying to put it back together again, sometimes with success, but it's a
really difficult situation that you don't want to get into if you can avoid it.
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