Perirectal Spacing for Prostate Cancer Therapy

Technique Description:

• 1) Minimally Invasive procedure to provide space between the prostate and anterior wall of the rectum prior to radiation therapy for prostate cancer
• 2) Transrectal ultrasound visualization to guide the procedure
• 3) Hydro dissection to open the space prior to the SpaceOAR Hydrogel injection
• 4) Preparation of the SpaceOAR Hydrogel kit
• 5) Injection of the SpaceOAR Hydrogel between the prostate and rectum

Procedure Steps:

• 1) Patient preparation Including local anesthesia application and patient positioning
• 2) Prostate fiducial marker placement
• 3) Hydro dissection procedure
• 4) SpaceOAR Hydrogel kit preparation
• 5) SpaceOar injection

Learning Points:

• Know prostate volume ahead of time
• Proper anesthesia technique for an outpatient procedure
• Take time to ensure needle placement below the Denonvilliers fascia
• Importance of excellent transrectal ultrasound quality in both the axial and sagittal views
• Proper SpaceOAR Hydrogel kit preparation
• Proper SpaceOAR Hydrogel injection anatomical location and technique

Clinical History:

• 72 y.o. male with cT2b Gleason 4+3(7) prostate cancer, PSA 12.4
• MRI of the prostate on 8/13/19 identified a 1.3 cm PIRADS 5 lesion in the left base to mid medial posterior peripheral zone
• Prostate biopsy identified Gleason 4+3(7) prostate cancer in four cores and Gleason 3+4(7) prostate cancer in three cores
• IPSS 15 (global 3), SHIM 10