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Updates in Rectal Protection during Prostate Radiation

Updates in Rectal Protection during Prostate Radiation

Years ago, almost all of our patients with prostate cancer were treated using a rectal balloon to help protect the rectum from radiation and potential side effects. It was practically a bonding experience between proton therapy prostate patients, due to the daily discomfort of inserting the rectal balloon. One Loma Linda patient even started a national group called Brotherhood of the Balloon! Recently, the number of patients treated using the balloon has fallen because of newer, less invasive methods of protecting the rectum and other organs.

One of these methods is SpaceOAR, the first FDA-approved injectable gel to protect the rectum in men undergoing radiation therapy for prostate cancer. The SpaceOAR System creates space to protect the rectum from radiation exposure by temporarily positioning the anterior rectum wall away from the prostate during treatment. Most of the patients we treat with low- or intermediate-risk prostate cancer now use SpaceOAR.

For patients with high-risk prostate cancer that may have or could spread outside the prostate, we either use no spacer at all or the balloon. The reason SpaceOAR is not generally utilized for high-risk prostate cancer is the concern that cancer cells outside the prostate could be pushed further away by the gel. The balloon is utilized if we are worried that radiation dose to the rectum is too high without it. However, with better imaging and targeting using fiducial markers, we can treat cancer within one millimeter of the target. Therefore we find that most high-risk patients who still have a prostate can be treated without a rectal balloon.  

We still use the balloon as a spacer when the patient has had his prostate removed. These patients receive proton therapy to the prostate bed to target any cancer cells left behind after surgery.

Though most patients can utilize less invasive techniques to protect the rectum, all of our prostate cancer patients still have to drink water to fill the bladder, which helps to lift the bladder up and away from the prostate – no balloons or SpaceOAR necessary! Now, rather than bonding oven an uncomfortable daily ritual, our prostate cancer patients can bond over the ease of treatment during their monthly Prostate Club dinners.