SpaceOAR - Augmenix, Boston Scientific, and Conflicts of Interest

[thesauce]

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So anyway, re space oar, is it allowed in high risk yet? Last I was aware, it was only okay in low and intermediate risk.

It is commonly used for high risk

 

[radoncftw]

It is commonly used for high risk

i agree. even node positive disease.

main concern has always been if there is significant EPE posteriorly

 

[BobbyHeenan]

So anyway, re space oar, is it allowed in high risk yet? Last I was aware, it was only okay in low and intermediate risk.

In the original randomized trial I *think* they omitted high risk.

I always get an MRI and if any concern for posterior or posterior-lateral ECE I don't recommend it, even if it is a soft call. The juice isn't worth the squeeze IMO.

I think other spaceOAR true believers go by no "gross" EPE posteriorly.

 

[evilbooyaa]

70/35 was equivalent in the rtog/calgb study

To 45/30... no QD arm has been proven to be equally efficacious to 60/40 or 54/30 SIB

 

[medgator]

https://www.practicalradonc.org/article/S1879-8500(25)00173-0/abstract

New complication I hadn't heard of but not surprised

 

[TheWallnerus]

https://www.practicalradonc.org/article/S1879-8500(25)00173-0/abstract

New complication I hadn't heard of but not surprised

The good news: SpaceOAR only seems to be responsible for 5 deaths... so far.

https://www.advancesradonc.org/article/S2452-1094(25)00111-3/fulltext

 

[Gfunk6]

But, come on, deaths are almost certainly not related to SpaceOAR and could have also happened with prostate biopsies or brachytherapy.

With respect to the reported deaths that could possibly have been related to the spacer and/or the spacer placement procedure, one occurred in 2018, following a high-dose-rate brachytherapy procedure and SpaceOAR placement; the patient developed a prostatic abscess and later died from alcoholic cardiomyopathy, with medical evaluation stating that the infection was not believed to be related to SpaceOAR. In 2019, a patient underwent a procedure to place low-dose-rate brachytherapy seeds and SpaceOAR; he experienced dizziness and nausea followed by cardiac arrest immediately after the procedure. In 2020, a patient experienced cardiopulmonary arrest after the procedure, with imaging performed during his workup that showed the spacer appropriately localized. In 2022, a patient experienced a vasovagal event followed by cardiac arrest after an aborted spacer placement procedure (event occurred on withdrawal of the ultrasound probe). In 2023, a patient again experienced cardiac arrest after the procedure, preceded by an event consistent with a vasovagal reaction (nausea, lightheadedness).

 

[RickyScott]

fistulas are a better measure and there apparently have been quite a few

 

[medgator]

fistulas are a better measure and there apparently have been quite a few

Exents

 

[OTN]

But, come on, deaths are almost certainly not related to SpaceOAR and could have also happened with prostate biopsies or brachytherapy.

Yes but biopsies and brachytherapy have a benefit to the patient

 

[evilbooyaa]

https://www.practicalradonc.org/article/S1879-8500(25)00173-0/abstract

New complication I hadn't heard of but not surprised

Have seen it. Didn't think it was case reportable. I was apparently incorrect...

 

[Ray D. Ayshun]

I think we're beginning to be removed from the Space OAR question. My urologist has apparently been convinced that I always want/need it. so patients are showing up to me with the procedure already scheduled or completed. Most recently, a guy with SVI and perirectal nodes...

 

[metallica81788]

I think we're beginning to be removed from the Space OAR question. My urologist has apparently been convinced that I always want/need it. so patients are showing up to me with the procedure already scheduled or completed. Most recently, a guy with SVI and perirectal nodes...

I think that was always going to happen either way depending on the individual urologist
The uro group I work with is very old school and don't like spaceOARS, so I've never been pushed to use them and even I changed my mind - they wouldn't.

 

[evilbooyaa]

I think we're beginning to be removed from the Space OAR question. My urologist has apparently been convinced that I always want/need it. so patients are showing up to me with the procedure already scheduled or completed. Most recently, a guy with SVI and perirectal nodes...

Maybe don't have such bad rectal toxicity in your f/u patients then that your urologist feels like you need it??

/s

But in seriousness, it's an easy procedure that gets reimbursed well especially in an ASC - you're surprised that a UROLOGIST of all specialties is inappropriately enthusiastic about it?

 

[radoncftw]

I think we're beginning to be removed from the Space OAR question. My urologist has apparently been convinced that I always want/need it. so patients are showing up to me with the procedure already scheduled or completed. Most recently, a guy with SVI and perirectal nodes...

yes same in my neck of the woods
I have to actually tell some of them when I really DO NOT want it.
other urologists are more thoughtful