Reducing Bowel Complications Following Radiation in Prostate Cancer

SpaceOAR Hydrogel reduces the risk of bowel complications and need for procedures like colonoscopy in prostate cancer patients receiving radiation therapy, study shows.

The utility of SpaceOAR Hydrogel, a polyethylene glycol-based hydrogel spacer placed between the prostate and rectum, led to a reduction in hazard of developing bowel disorders as well as a reduction in requirement of procedures such as colonoscopy in patients undergoing radiation therapy for prostate cancer, according to a study published in JAMA Network Open.

Because of the rectum’s close proximity to the prostate, radiation exposure due to prostate cancer treatment can lead to complications such as diarrhea, rectal bleeding and discomfort during bowel movements. In some cases, these side effects can be severe enough to require medical intervention, impacting a patient’s quality of life after treatment ends. 

In order to address these needs, investigators launched a retrospective cohort study of SpaceOAR to better understand the incidence of radiation-related bowel toxicity, including bowel disorders and related medical procedures, among patients who received radiation therapy for prostate cancer.

Dr. Ron Morton, the chief medical officer and vice president of medical affairs of Urology at Boston Scientific, sat down for an interview with CURE to discuss what these findings mean for patients considering radiation therapy, the broader implications for long-term bowel health and questions patients should ask their oncologists when evaluating their treatment options.

CURE: How does radiation therapy for prostate cancer impact bowel health, and why is minimizing bowel toxicity a critical concern for patients?

Morton: Radiation therapy aims to kill cancer cells while avoiding damage to surrounding healthy tissue. But radiation to treat prostate cancer can cause damage to the rectum due to its proximity to the prostate, which can lead to issues with bowel function, including diarrhea, painful bowel movements and rectal bleeding.

These side effects can negatively impact patients’ quality of life. And in rare cases, these complications can be serious and require hospitalization or surgical intervention to manage.

Can you explain how SpaceOAR Hydrogel works and why it is an option for patients undergoing radiation therapy for prostate cancer?

SpaceOAR Hydrogel is an absorbable polyethylene glycol (PEG)-based hydrogel that temporarily creates space between the prostate and rectum. It’s designed to reduce the radiation dose delivered to the rectum during radiation therapy to help lessen damage to the rectum and minimize side effects.

The procedure to place SpaceOAR is minimally invasive and typically happens in an outpatient setting – a doctor’s office, hospital or clinic. It’s composed of biodegradable material and is naturally absorbed by the body after approximately six months. SpaceOAR is an option for patients because it may help maintain a patient’s quality of life and reduce the often frustrating and embarrassing side effects of radiation therapy.

The recent study published in JAMA Network Open found that patients receiving SpaceOAR had a 25% lower hazard of developing bowel disorders. What does this mean for patients considering radiation therapy?

In this large retrospective database review of patients with prostate cancer, those who received SpaceOAR as part of their treatment had a significantly lower chance of developing bowel complications due to radiation therapy as compared to patients that did not receive SpaceOAR as part of their treatment.

The findings of this study are consistent with other clinical trial results, further supporting SpaceOAR as a safe and effective treatment option that can potentially protect quality of life for prostate cancer patients. This is good news for patients who are considering radiation therapy for prostate cancer and want to minimize bowel-related side effects.

Many patients worry about long-term side effects of treatment. How does the use of SpaceOAR Hydrogel compare to not using it in terms of bowel-related quality of life years after treatment?

The study findings show that the use of SpaceOAR was associated with a significant reduction in the incidence of bowel disorders and related procedures in the four years after radiation treatment. A cancer diagnosis can be scary and overwhelming, and patients are often faced with having to make challenging decisions about their treatment plans. Knowing that SpaceOAR can help minimize long-term side effects of radiation therapy and maintain quality of life post-treatment can hopefully ease some of the concern’s patients may have as they make those important decisions.

This study also found that patients who received SpaceOAR had a 46% lower hazard of requiring procedures such as colonoscopies and rectal resections. How significant is this reduction for a patient’s long-term health and overall quality of life?

The significant reduction of bowel-related procedures in the SpaceOAR group compared to the non-SpaceOAR group is indicative of the ability of SpaceOAR to preserve normal bowel function and help protect quality of life for patients undergoing radiation therapy for prostate cancer. Anecdotally, what I’ve heard from fellow physicians is that because of the higher risk of bowel complications with stereotactic body radiation therapy (SBRT), many of them won’t perform SBRT without placing a perirectal spacer.

What should patients ask their oncologists about SpaceOAR to determine whether it is the right option for their specific case?

SpaceOAR Hydrogel is widely available in the United States and covered by many insurance plans. It’s also available globally in many countries where contemporary radiation therapy techniques are practiced.

I encourage patients to engage in shared decision-making with their care team about their prostate cancer treatment. Available options, including surgery, radiation therapy and watchful waiting should be considered. Patients who decide to undergo radiation therapy should discuss with their physician the risks and benefits of including a perirectal spacer such as SpaceOAR in their treatment plan.

Reference:

“Bowel Disorder Incidence and Rectal Spacer Use in Patients With Prostate Cancer Undergoing Radiotherapy” by Dr. Michael R. Folkert, et al., JAMA Network Open.

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