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Urology 2019

How the side effects of prostate cancer radiotherapy can be reduced

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Professor Amit Bahl

Consultant Clinical Oncologist and Clinical Director, The Bristol Haematology & Oncology Centre

Alan Clarke

Typical prostate cancer treatment plans include a high dose of radiotherapy that aims to effectively kill cancer cells so they cannot spread any further.


However, due to the prostate being close to other organs and tissues, such as the rectum, there is a risk of long-term damage and side effects such as rectal pain, bowel and urinary leakage and sometimes erectile dysfunction.

How can we overcome the challenge of the prostate’s location?

In addition to the proximity of the prostate and important body parts, “the prostate moves when a patient breathes,” says Professor Bahl, Consultant Clinical Oncologist and Clinical Director based at The Bristol Haematology & Oncology Centre.

“And despite all technical advances, it means we just can’t be that accurate with radiotherapy.”

However, a new technique is actually giving about a centimetre of additional space, for the clinician to see a clearer margin between the organs during radiotherapy.

This is achieved when a water-based hydrogel – inserted via a fine needle into the prostate, under anaesthetic – fills the cavity between the prostate and rectum.

Being able to administer radiotherapy with this added space “means that essentially the outcomes are the same, but the long-term side effects are much better” says Bahl. In studies, its use has been shown to reduce life-changing side effects, such as rectal pain, by more than 70%.

Alan’s experience with prostate cancer treatment

That was certainly the case for 71-year old Alan Clarke, who was the first patient to have the hydrogel treatment at Bristol earlier this year.

“My diagnosis came about after a random check on my PSA level; my GP sent me for a biopsy as my results were borderline and it turned out that there were cancer cells within my prostate. I had to have 37 doses of radiotherapy, five days a week for seven weeks.”

We have always been big on travel in my family, so I’m very glad the treatment allowed me to continue with my plans so quickly with no real side effects.

Alan’s treatment worked; over the past 9-years, he has had regular check-ups, but earlier this year, his PSA results showed that something was wrong.

“When I heard that the cancer had come back, I knew that there would be complications because of my previous treatment. I had a big holiday to Australia coming up to celebrate my step-daughter’s and great-granddaughter’s birthdays, so I just hoped I would be able to go.”

“Day surgery allowed me to continue my travel plans”

Alan met Professor Bahl at The Bristol Haematology & Oncology Centre and was told about the gel. Alan was deemed the perfect patient to receive the spacer as he was more likely to receive potential side effects due to his previous treatment.

Alan was allowed home the same day as his procedure, and, after one dose of high-intensity radiotherapy, he was allowed to travel the next month.

“We have always been big on travel in my family, so I’m very glad the treatment allowed me to continue with my plans so quickly with no real side effects. I’ve now got a cruise booked to Canada in October and can’t wait to see what it’s like in the autumn.”

Spacer gel being rolled out across NHS England

Now the spacer gel is available in several hospitals across England, and is covered by all major private insurance providers, but Professor Bahl is hoping it will be made available more widely in the future.

“If it is not being offered in your local hospital, then discuss with your clinical oncologist other avenues for receiving this treatment.”

The ITP programme aims to approve a reimbursement for all men considered eligible to have the new spacer gel inserted.

Alan highly recommends the treatment. He says: “I had an epidural so, from waist down I was numb. I was little uncomfortable over the next few days, but that was to be expected. Now, my life is back to normal; I go on long haul flights, shopping trips with the wife and do the gardening. If you’re considering radiotherapy: go for it.”

SpaceOAR hydrogel is clinically proven, minimally invasive spacer designed to minimise urinary, sexual, bowel side effects and protect quality of life for prostate cancer patients undergoing radiation therapy.

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.
There are risks associated with all medical procedures. Please talk with your doctor about the risks and benefits associated with SpaceOAR Hydrogel. Potential complications associated with SpaceOAR Hydrogel include, but are not limited to: inflammatory reactions, infection, bleeding, and pain or discomfort from the injection.
CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings and instructions for use can be found in the product labelling supplied with each device. Information for use only in countries with applicable health authority registrations. This material not intended for use in France.

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