Perirectal Spacing for Prostate Cancer Therapy - Part 2

Technique Description:

• 1) Minimally Invasive procedure to create space between the prostate and the 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 Denonvilliers fascia.
• Importance of excellent transrectal ultrasound quality. In both the axial and sagittal views.
• Proper SpaceOAR Hydrogel injection anatomical location and technique.

Clinical History:

• Patient #1:
• 62-year-old male.
• PSA: 8.5.
• Abnormal DRE.
• Gleason 7.
• Short course of ADT + EBRT 7920 cGy.
• Patient #2:
• 68-year-old male.
• PSA: 12.
• Normal DRE.
• Gleason 9.
• ADT, EBRT plus brachytherapy.