SpaceOAR - Augmenix, Boston Scientific, and Conflicts of Interest

[wandering star]

The interesting part is the patent initially filed in 2003 and what patents mean (this I don't know). The patent is for a strategy. It is not regarding a specific formulation or protocol creating the rectal prostate space. Other people figured out what formulation worked for creating the space at relatively low cost. I do not know if there was any remuneration to the Hopkins folks who tried the PEG concept for spacer.

There are only four kinds of patents out there in the US: device patents, methods patents, state-of-matter patents, and manufacture patents. This one is a methods patent, which as you say it, is a strategy. (A prototypical drug patent is a state-of-matter patent, for comparison).

The classic IP strategy if you are first in the space would be to patent the method. This allows you to claim the most "thought territory" because it is hard to work around (unless someone invents a shortcut that skips one of your claimed steps, in which case your patent is bunk). If you patented only the formulation you would be very vulnerable to someone coming up with a better (or simply different) formulation, for example, and working around you.

One compromise is to claim a desired formulation in your methods patent in a dependent claim, which sort of makes it an added ingredient but not the main substance. This is done in your linked patent in Claims 6 to 14, where they try to cram in every plausible formulation they can think of so no one is going to go around them later and claim a better filler material. They list PEG as the material in Claim 11.

Filing a patent in 2003 gives you the potential for a future payout if you invest more deeply in the space and find a winner. However, university patents are on the whole only moderately profitable, and most individual patents will not recoup the filing expenses. Assuming the $16 M payout was for the patent, this one would have been one of the rare winners.

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[medgator]

So you are telling me you think the standard of care for prostate IGRT is kv/kv match with fiducials and no cbct because of financial toxicity? That is great. You don't care about rectal or bladder filling? The majority of radiation oncologists in this country are using CBCT with or without fiducials, being concerned about the financial toxicity of a CBCTs in prostate cancer is certainly a novel take

Does it need to be daily when it can cost 50%+ more with extra table time? Once a week is fine unless you have data to suggest otherwise. And I'm sure you're reviewing it daily before treatment and confirming the accuracy of your therapists correct? and having the pt get off if it isn't perfect right?

 

[TheWallnerus]

CBCT without fiducials for mine.

The goal is to do the most with the least potential for harm. SpaceOAR and fiducials are invasive procedures with rare but bad/potentially catastrophic side effects that add next to nothing.

FWIW, I have done in the neighborhood of 2000 fiducial placements (2000 patients, times 4 fiducial placements... maybe 8000 placements!). I have never had anything "catastrophic." I have had a few guys get a transient fever. Never any residual acute or late urinary or bowel issues.

Adding "next to nothing" vs CBCT, I would tend to agree: clinically, nothing. Mathematically, along the lines of Stroom, Heijmen, Van Herk... the fiducials add statistically significantly something. But that is moot. It's only clinical outcomes that matter. And clinically I can't tell a difference between CBCT and kV fiducials. The mathematical discussions though are interesting and *could* be clinically pertinent. This is something I would have rigorously pursued were I in academics!

 

[medgator]

FWIW, I have done in the neighborhood of 2000 fiducial placements (2000 patients, times 4 fiducial placements... maybe 8000 placements!). I have never had anything "catastrophic." I have had a few guys get a transient fever. Never any residual acute or late urinary or bowel issues.

Adding "next to nothing" vs CBCT, I would tend to agree: clinically, nothing. Mathematically, along the lines of Stroom, Heijmen, Van Herk... the fiducials add statistically significantly something. But that is moot. It's only clinical outcomes that matter. And clinically I can't tell a difference between CBCT and kV fiducials. The mathematical discussions though are interesting and *could* be clinically pertinent. This is something I would have rigorously pursued were I in academics!

It's not hard to look up the cpt code for stereoscopic CT igrt vs kv and see the difference under the Medicare PFS. Not exactly a trivial difference in reimbursement either.

Igrt shaming is the new fraction shaming i guess except now they are ok with costing the system more?

It would make sense if the data was there. It isn't. Unless they want to pull out that proton/parachute analogy nonsense

 

[deleted1111261]

I would cbct everything at every site every day if I could. That’s how I’d want to be treated. Bladder filling / rectal volume is important. I don’t need data to know that visualizing target and adjacent structures is not bad medicine. The cost is not my problem. I’m hospital based and it’s bundled into prostate IMRT. It’s good practice. I’m not saying KV + fiducials. I just would want less things jammed in rectum and sharp things poking me. That’s not a big ask.

 

[Mandelin Rain]

FWIW, I have done in the neighborhood of 2000 fiducial placements (2000 patients, times 4 fiducial placements... maybe 8000 placements!). I have never had anything "catastrophic." I have had a few guys get a transient fever. Never any residual acute or late urinary or bowel issues.

Adding "next to nothing" vs CBCT, I would tend to agree: clinically, nothing. Mathematically, along the lines of Stroom, Heijmen, Van Herk... the fiducials add statistically significantly something. But that is moot. It's only clinical outcomes that matter. And clinically I can't tell a difference between CBCT and kV fiducials. The mathematical discussions though are interesting and *could* be clinically pertinent. This is something I would have rigorously pursued were I in academics!

Catastrophic was reserved for SpaceOAR. I’ve seen some patients who had pretty nasty infections with fiducials when the urologists were still doing them though.

 

[TheWallnerus]

I just would want less things jammed in rectum and sharp things poking me.

I was going "all across" America training urologists and rad oncs how to put in the fiducials late aughts. I'm like, "Oh yeah, it's easy, guys tolerate it great. You will be pleasantly surprised!" So the first patient I am trying with this timid rad onc in Kentucky, the moment I put in the ultrasound probe... this guy starts screaming and moaning. Like his wails echoed throughout the whole department like the shooting death scene in RoboCop. Sweat was pouring from the poor guy's face. God must have blessed him with the most exquisite rectal nociception known to man. I just kept 'er level and got done in ~90 seconds like I usually do. I look over at my rad onc buddy and he looked worse than the patient.

Anyways, that's thankfully my one dramatic story about fiducials, and it was a long time ago.

 

[Palex80]

Meanwhile, on Twitter

 

[elementaryschooleconomics]

I was going "all across" America training urologists and rad oncs how to put in the fiducials late aughts. I'm like, "Oh yeah, it's easy, guys tolerate it great. You will be pleasantly surprised!" So the first patient I am trying with this timid rad onc in Kentucky, the moment I put in the ultrasound probe... this guy starts screaming and moaning. Like his wails echoed throughout the whole department like the shooting death scene in RoboCop. Sweat was pouring from the poor guy's face. God must have blessed him with the most exquisite rectal nociception known to man. I just kept 'er level and got done in ~90 seconds like I usually do. I look over at my rad onc buddy and he looked worse than the patient.

Anyways, that's thankfully my one dramatic story about fiducials, and it was a long time ago.

It really is fascinating, witnessing each guy's tolerance (or lack thereof) to this. I won't lie - your patient's reaction is exactly what I expect every time we do it. But...I would agree with you, most tolerate it great. That's why the Lord gave us Ativan I guess.

Meanwhile, on Twitter

If folks are out there dropping SpaceOAR in M1 patients, you have truly drank the entire pitcher of Kool-Aid.

 

[evilbooyaa]

No SpaceOAR except for SBRT.
No fiducials except when patient getting SpaceOAR anyways and it's one procedure with 4 instead of 1 needle pokes while patient under local.

Daily CBCT.
Fiducials + KV doesn't show me anything about bladder or rectal filling. If the extra time on table makes you run late, who cares? I'd venture the cost-effectiveness of not having needles shoved into your prostate would outweigh the increased costs of doing a CBCT.

But the gator is in a unique scenario - can't do 4D scans for definitive lung cancer because the throughput is too high. Don't see most worried about on-table time for a CBCT as a reason to do something more invasive. If your therapists suck and are anxious, train better ones and pay them well so they don't leave would be my recommendation.

 

[medgator]

But the gator is in a unique scenario - can't do 4D scans for definitive lung cancer because the throughput is too high. Don't see most worried about on-table time for a CBCT as a reason to do something more invasive. If your therapists suck and are anxious, train better ones and pay them well so they don't leave would be my recommendation.

Not as unique as you might think... Maybe when you get board certified and ever move on to another job, you'll find out that out?

In the meanwhile, maybe you could share some data regarding weekly vs daily cbct with fiducials? Certainly more useful than the shade and smugness/superiority

 

[metallica81788]

Not as unique as you might think... Maybe when you get board certified and ever move on to another job, you'll find out that out?

In the meanwhile, maybe you could share some data regarding weekly vs daily cbct with fiducials? Certainly more useful than the shade and smugness/superiority

No way you believed the 4D CT lung situation wouldn't come back up again here right

 

[medgator]

No way you believed the 4D CT lung situation wouldn't come back up again here right

Doing ITVs on n3 patients. Makes plenty of sense, right @seper ?

 

[evilbooyaa]

Not as unique as you might think... Maybe when you get board certified and ever move on to another job, you'll find out that out?

In the meanwhile, maybe you could share some data regarding weekly vs daily cbct with fiducials? Certainly more useful than the shade and smugness/superiority

Getting BC went fine my dude, thanks for asking! And, why move on if I'm happy with where I am?

I will agree that weekly CBCT with daily kV on fiducials is probably fine!

I don't do or request fiducials, so my folks get daily CBCT. Multiple ways to skin the cat. I won't antagonize further. I'm just sayin', there are multiple practice patterns out there, and, IMO, the defense of time on table for a prostate patient to justify putting fiducials in them in 2022... I just can't get on board with that.

 

[Ray D. Ayshun]

Getting BC went fine my dude, thanks for asking! And, why move on if I'm happy with where I am?

I will agree that weekly CBCT with daily kV on fiducials is probably fine!

I don't do or request fiducials, so my folks get daily CBCT. Multiple ways to skin the cat. I won't antagonize further. I'm just sayin', there are multiple practice patterns out there, and, IMO, the defense of time on table for a prostate patient to justify putting fiducials in them in 2022... I just can't get on board with that.

I'm also not a big fan of kV ability to confirm bladder fill.

 

[deleted1111261]

Getting BC went fine my dude, thanks for asking! And, why move on if I'm happy with where I am?

I will agree that weekly CBCT with daily kV on fiducials is probably fine!

I don't do or request fiducials, so my folks get daily CBCT. Multiple ways to skin the cat. I won't antagonize further. I'm just sayin', there are multiple practice patterns out there, and, IMO, the defense of time on table for a prostate patient to justify putting fiducials in them in 2022... I just can't get on board with that.

I have posted a poll on the Bird

 

[jondunn]

 

[Ray D. Ayshun]

Gosh, Finally. There's finally a study looking at adt duration in prostate cancer. This should change things.

 

[Aphtalyfe]

Without going into the risks/benefits of SpaceOAR... A challenger appears.

Barrigel - Palette Life Sciences

This is a hard coded page. Only the Metadata should be changed here.

www.palettelifesciences.com

 

[elementaryschooleconomics]

Also, if you bail on academia to join Wally and the Gang™ you can take all the Boston Scientific money you want, right?

 

[Mandelin Rain]

I am submitting my own product for FDA approval as well.

Brand name: GoochyGoochyGoo TM

 

[TheWallnerus]

I am submitting my own product for FDA approval as well.

Brand name: GoochyGoochyGoo TM

That or... The Blob™℠®©

 

[deleted941485]

Also, if you bail on academia to join Wally and the Gang™ you can take all the Boston Scientific money you want, right?

View attachment 348542

Because God Knows academia wasnt doing them any favors.

 

[jondunn]

Because God Knows academia wasnt doing them any favors.

You’ve posted before about struggling in your academic position. Do you believe you have what it takes to join us in community practice?

 

[medgator]

Getting BC went fine my dude, thanks for asking! And, why move on if I'm happy with where I am?

I will agree that weekly CBCT with daily kV on fiducials is probably fine!

I don't do or request fiducials, so my folks get daily CBCT. Multiple ways to skin the cat. I won't antagonize further. I'm just sayin', there are multiple practice patterns out there, and, IMO, the defense of time on table for a prostate patient to justify putting fiducials in them in 2022... I just can't get on board with that.

"Therapist reliability"

"Dose-volume histograms were generated and showed that test-retest variability associated with ST-CBCT IG-alignments resulted in significantly increased dose to normal structures and a reduced planning target volume dose in many patients."

@jondunn @metallica81788 @Ray D. Ayshun

Guess there is data out there after all... does Matt katz need to stop working with ****ty therapists as well @evilbooyaa ?

 

[deleted941485]

You’ve posted before about struggling in your academic position. Do you believe you have what it takes to join us in community practice?

I’ve started a job search specifically for a community practice. My dissatisfaction…It’s been building for quite some time. The conversations that go no where. The endless requests for help on metanalysis I don’t care about. No new drugs or tech…just a never ending conveyer belt of nonsense and exploitation.

I don’t know if I have what it takes but it might be worth a shot if someone was willing to hire me.

My other option is to leave practice entirely head to industry or retrain. My family won’t like it but tough…it’s not like I’m anything more than a cash machine to them anyway.

 

[medgator]

I’ve started a job search specifically for a community practice. My dissatisfaction…It’s been building for quite some time. The conversations that go no where. The endless requests for help on metanalysis I don’t care about. No new drugs or tech…just a never ending conveyer belt of nonsense and exploitation.

I don’t know if I have what it takes but it might be worth a shot if someone was willing to hire me.

My other option is to leave practice entirely head to industry or retrain. My family won’t like it but tough…it’s not like I’m anything more than a cash machine to them anyway.

There are decent employed jobs in many parts of the country right now if you are BC with experience. Definitely worth a shot to keep looking imo

 

[elementaryschooleconomics]

I’ve started a job search specifically for a community practice. My dissatisfaction…It’s been building for quite some time. The conversations that go no where. The endless requests for help on metanalysis I don’t care about. No new drugs or tech…just a never ending conveyer belt of nonsense and exploitation.

I don’t know if I have what it takes but it might be worth a shot if someone was willing to hire me.

My other option is to leave practice entirely head to industry or retrain. My family won’t like it but tough…it’s not like I’m anything more than a cash machine to them anyway.

Community practice is the best, I'm obviously biased though.

Now, the conversations that go nowhere...well, you can't avoid those. But you can wave your fist and say "you know who pays the bills 'round here?!?!?!?"

(note: don't actually wave your fist and say that)

 

[deleted1111261]

I’ve started a job search specifically for a community practice. My dissatisfaction…It’s been building for quite some time. The conversations that go no where. The endless requests for help on metanalysis I don’t care about. No new drugs or tech…just a never ending conveyer belt of nonsense and exploitation.

I don’t know if I have what it takes but it might be worth a shot if someone was willing to hire me.

My other option is to leave practice entirely head to industry or retrain. My family won’t like it but tough…it’s not like I’m anything more than a cash machine to them anyway.

I think that the Gator is right. There are reasonably good employed positions, many paying the median or more. Gotta get beyond living in certain cool locales. The Pittsburgh, Detroit, Kansas City, Minneapolis, etc jobs. Check more than ASTRO - check practice link, linked in, monster, etc. check with recruiters about locums to perm.

“It’s not 1999, but it’s not literal breadlines (yet)”
-#radoncrocks

 

[deleted941485]

I think that the Gator is right. There are reasonably good employed positions, many paying the median or more. Gotta get beyond living in certain cool locales. The Pittsburgh, Detroit, Kansas City, Minneapolis, etc jobs. Check more than ASTRO - check practice link, linked in, monster, etc. check with recruiters about locums to perm.

“It’s not 1999, but it’s not literal breadlines (yet)”
-#radoncrocks

Its a challenge. I'm over the MW tbh and about 2 seconds away from being over RO.

I remember interviewing for a job that was "in kansas city" only to be told id be working in bolivar MO. Medicine is a dirty business but RO may be the dirtiest shell game around. Im starting to think the paycut doing 5 years of a new residency may be worth it if you have no chance of ever making even median MGMA

 

[evilbooyaa]

"Therapist reliability"

"Dose-volume histograms were generated and showed that test-retest variability associated with ST-CBCT IG-alignments resulted in significantly increased dose to normal structures and a reduced planning target volume dose in many patients."

Guess there is data out there after all... does Matt katz need to stop working with ****ty therapists as well@evilbooyaa ?

I agree that the bolded line was in poor taste in my previous post, and I apologize for it. May have been salty about non-SDN things and projecting that onto SDN. Not a good look.

Mea culpa, gator.

In regards to the study by Katz, I'm not surprised that lining to fiducials is easier than CBCT... I think that would be the case for therapists, physicians, etc.

I predict the main reason physicians like fiducials + kV is because it gets them called to the machine less, decreases frequency of patient having to be taken off the table (can't take patient off table for rectum/bladder filling if you don't CBCT for it), and/or increases throughput on the machine (due both to time required for CBCT and the previous point). I suppose I don't work in a practice busy enough to ever have to get called for that or have to stay later due to repeated CBCTs on fractions when patients can't get it right. Suppose it would be multiplicative as well - if you have 20 prostates on Tx, worse than if you have 2.

 

[deleted1111261]

Survey showed that 14% used kV daily.

 

[Neoprene]

Late to this party, but thought I'd mention that I've personally found spacers to be helpful in achieving safe DIL boosts for posterior lesions. Respecting hypofrac rectal constraints in particular can otherwise preclude significant dose escalation there. Others had that experience?

Iodinated contrast in the new spacers has also been nicely visible on CBCTs which has upped my confidence in therapist daily setup to that steep dose gradient area, translating to more comfort with tighter PTV margin.

Between the two I feel like there's practical value in therapeutic ratio improvement. Otherwise agree general toxicity benefit reported on trial was relatively small (if I remember correctly something like a NNT of 24 patients to avoid one G2 rectal toxicity).

 

[Aphtalyfe]

Late to this party, but thought I'd mention that I've personally found spacers to be helpful in achieving safe DIL boosts for posterior lesions. Respecting hypofrac rectal constraints in particular can otherwise preclude significant dose escalation there. Others had that experience?

Iodinated contrast in the new spacers has also been nicely visible on CBCTs which has upped my confidence in therapist daily setup to that steep dose gradient area, translating to more comfort with tighter PTV margin.

Between the two I feel like there's practical value in therapeutic ratio improvement. Otherwise agree general toxicity benefit reported on trial was relatively small (if I remember correctly something like a NNT of 24 patients to avoid one G2 rectal toxicity).

Which spacer has iodinated contrast that can be seen on CBCT?

 

[elementaryschooleconomics]

Which spacer has iodinated contrast that can be seen on CBCT?

SpaceOAR VUE

It's what I exclusively use now, if I'm placing the gel in someone. It shows up great.

 

[Radonky]

Yea we use VUE as well, so far we like it

 

[DoctwoB]

Catastrophic was reserved for SpaceOAR. I’ve seen some patients who had pretty nasty infections with fiducials when the urologists were still doing them though.

If you are doing anything in the prostate transrectally, there will be a risk of infection. The question is what is the risk and how far should we go to avoid it? Historic series have TRUS biopsy infection rates of 2-4%. Modern series using augmented prophylaxis regimens (either 2nd antibiotic like a shot of gent, stool culture directed antibiotic, or sterilizing the needle in formalin between passes have shown infection rates more along the lines of 0.5-1%. Personally my rate is about 0.75%, (typically a simple UTI/prostatitis) of which none have required admission, though there is luck involved and eventually I will have a case of sepsis.

In Urology one of the big academic virtue signaling things is to switch to transperineal biopsy to lower the infection risk from ~1% to 0.1%. This comes at the expense of a higher cost (using expensive needle guides that cost almost as much as the procedure reimburses, sometimes needing a new ultrasound machine), more pain, sometimes being done under anesthesia, and higher rates of urinary retention, along with a new learning curve. But as always there are zealots who yell it MUST be done that way to lower the risk of infection and because "antibiotic stewardship" like a shot of gent at the time of the biopsy contributes meaningfully to our antibiotic issues. I can't speak to the benefits of fiducials, but I'd argue the risk is low.

 

[Aphtalyfe]

Yea we use VUE as well, so far we like it

It stays radiopaque the entire course of treatment? Didn't realize that!

If you are doing anything in the prostate transrectally, there will be a risk of infection. The question is what is the risk and how far should we go to avoid it? Historic series have TRUS biopsy infection rates of 2-4%. Modern series using augmented prophylaxis regimens (either 2nd antibiotic like a shot of gent, stool culture directed antibiotic, or sterilizing the needle in formalin between passes have shown infection rates more along the lines of 0.5-1%. Personally my rate is about 0.75%, (typically a simple UTI/prostatitis) of which none have required admission, though there is luck involved and eventually I will have a case of sepsis.

In Urology one of the big academic virtue signaling things is to switch to transperineal biopsy to lower the infection risk from ~1% to 0.1%. This comes at the expense of a higher cost (using expensive needle guides that cost almost as much as the procedure reimburses, sometimes needing a new ultrasound machine), more pain, sometimes being done under anesthesia, and higher rates of urinary retention, along with a new learning curve. But as always there are zealots who yell it MUST be done that way to lower the risk of infection and because "antibiotic stewardship" like a shot of gent at the time of the biopsy contributes meaningfully to our antibiotic issues. I can't speak to the benefits of fiducials, but I'd argue the risk is low.

Fiducials can be placed transperineal without sedation and with lower risk of infection.

But I agree that transperineal biopsies are kind of a pain... even for us brachytherapists who do most things transperineal.

 

[BobbyHeenan]

Re: spaceOAR VUE.

I have asked if we can get it and/or the urology groups that place it use it but I'm told the whole spaceOAR procedure nets them very little money and the VUE is even more expensive, so they decline unless the patient cannot get an MRI.

Anyone else hear this?

 

[metallica81788]

Re: spaceOAR VUE.

I have asked if we can get it and/or the urology groups that place it use it but I'm told the whole spaceOAR procedure nets them very little money and the VUE is even more expensive, so they decline unless the patient cannot get an MRI.

Anyone else hear this?

I've heard this before.

Then something happened after I told urology and the spaceOAR reps that I only wanted VUE to avoid extra MRIs (take forever to get done) and voila magic and all they have is VUE now. Unsure of the economics of that.

 

[DoctwoB]

It stays radiopaque the entire course of treatment? Didn't realize that!



Fiducials can be placed transperineal without sedation and with lower risk of infection.

But I agree that transperineal biopsies are kind of a pain... even for us brachytherapists who do most things transperineal.

Don’t get me wrong, there’s nothing wrong with transperineal biopsy, fiducials, etc. In the hands of a skilled operator it can be reasonably quick, not too painful, and done at a similar cost (using either reusable grids, freehand; or angiocath technique) assuming you already have the necessary equipment. It is the implication that is substandard care or the “standard of care” needs to shift coming from many in academia with nothing better to do that bugs me. To ask a private practice Uro to buy a new 50k ultrasound to do TP bx or send his biopsies to an academic center to have a slightly lower infection risk at the expense of more pain/retention is ridiculous.

 

[RickyScott]

It stays radiopaque the entire course of treatment? Didn't realize that!



Fiducials can be placed transperineal without sedation and with lower risk of infection.

But I agree that transperineal biopsies are kind of a pain... even for us brachytherapists who do most things transperineal.

A 1% infection rate offsets the absolute benefit of fiducials or space oar over cbct.

 

[medgator]

Don’t get me wrong, there’s nothing wrong with transperineal biopsy, fiducials, etc. In the hands of a skilled operator it can be reasonably quick, not too painful, and done at a similar cost (using either reusable grids, freehand; or angiocath technique) assuming you already have the necessary equipment. It is the implication that is substandard care or the “standard of care” needs to shift coming from many in academia with nothing better to do that bugs me. To ask a private practice Uro to buy a new 50k ultrasound to do TP bx or send his biopsies to an academic center to have a slightly lower infection risk at the expense of more pain/retention is ridiculous.

That's the biggest hurdle I've seen for many to switch from TR to TP. Have to do a lot of 'em to pay off the U/S setup

 

[medgator]

A 1% infection rate offsets the absolute benefit of fiducials or space oar over cbct.

Other things to consider....

 

[RickyScott]

From my experience with calypso years ago, intrafraction motion is largely a non issue. It does happen, but is generally very momentary (passing of gas pocket). I can assure you that a very large academic center treating a lot of prostates almost never beamed off due to displacement of calypso beacon. Maybe for 5 seconds the ptv would only have 94% coverage etc. I would liken it to worrying about heterogeneity corrections for Iv contrast during simulation.

 

[evilbooyaa]

SpaceOAR Vue is very nice and I would recommend that over regular SpaceOAR for any patient or physician who was going to be having SpaceOAR as part of their treatment. Very easy to identify on CBCT

 

[SneakyBooger]

Well, if you get your prostate treated in the UK (or perhaps some other 2nd/3rd world country) your risk of "severe gastrointestinal toxicity" is 11% within 2 years of receiving XRT, according to their 2020 report: "Results of the NPCA Prospective Audit in England and Wales for men diagnosed from 1 April 2018 to 31 March 2019 (published January 2021)".

11% seems extremely high.

Are they treating all of their prostate cancers with protons or something?!

Perhaps coincidentally (or not), the rate of "severe gastrointestinal toxicity" increased from 10% (as reported in 2019) to 11% (as currently reported) -- and the use of moderately hypofractionated XRT also increased from 91% (2019) to 96% (2021).

"Hypothesis generating"?

Certainly, there can be no relation!! Blasphemy!!

SneakyBooger should be banned already!!

 

[medgator]

Well, if you get your prostate treated in the UK (or perhaps some other 2nd/3rd world country) your risk of "severe gastrointestinal toxicity" is 11% within 2 years of receiving XRT, according to their 2020 report: "Results of the NPCA Prospective Audit in England and Wales for men diagnosed from 1 April 2018 to 31 March 2019 (published January 2021)".

11% seems extremely high.

Are they treating all of their prostate cancers with protons or something?!

Perhaps coincidentally (or not), the rate of "severe gastrointestinal toxicity" increased from 10% (as reported in 2019) to 11% (as currently reported) -- and the use of moderately hypofractionated XRT also increased from 91% (2019) to 96% (2021).

"Hypothesis generating"?

Certainly, there can be no relation!! Blasphemy!!

SneakyBooger should be banned already!!






View attachment 348821

There is zero benefit to hypofx compared to conventional fx in prostate, unlike breast, if we are talking clinical outcomes. None. It's just faster and cheaper

 

[elementaryschooleconomics]

Well, if you get your prostate treated in the UK (or perhaps some other 2nd/3rd world country) your risk of "severe gastrointestinal toxicity" is 11% within 2 years of receiving XRT, according to their 2020 report: "Results of the NPCA Prospective Audit in England and Wales for men diagnosed from 1 April 2018 to 31 March 2019 (published January 2021)".

11% seems extremely high.

Are they treating all of their prostate cancers with protons or something?!

Perhaps coincidentally (or not), the rate of "severe gastrointestinal toxicity" increased from 10% (as reported in 2019) to 11% (as currently reported) -- and the use of moderately hypofractionated XRT also increased from 91% (2019) to 96% (2021).

"Hypothesis generating"?

Certainly, there can be no relation!! Blasphemy!!

SneakyBooger should be banned already!!

I know a few people on SDN say this line a lot, but it's true - based on this definition of "Grade 3 GI Toxicity", the act of placing the SpaceOAR qualifies. 100% of men with SpaceOAR experience a Grade 3 GI toxicity.

Now, saying this isn't necessarily arguing in good faith, obviously. You can see what codes they used to arrive at the 11% in the Supplement:

There isn't a more granular breakdown that I'm finding as of yet.

However, something as "simple" as a proctoscopy and a diagnosis of gastroenteritis is being defined as a Grade 3.

It all depends on how trigger happy these NHS GI docs are with their rigid sigs, I guess.

 

[Mandelin Rain]

View attachment 348824

I know a few people on SDN say this line a lot, but it's true - based on this definition of "Grade 3 GI Toxicity", the act of placing the SpaceOAR qualifies. 100% of men with SpaceOAR experience a Grade 3 GI toxicity.

Now, saying this isn't necessarily arguing in good faith, obviously. You can see what codes they used to arrive at the 11% in the Supplement:

View attachment 348826

There isn't a more granular breakdown that I'm finding as of yet.

However, something as "simple" as a proctoscopy and a diagnosis of gastroenteritis is being defined as a Grade 3.

It all depends on how trigger happy these NHS GI docs are with their rigid sigs, I guess.

11% at two years? On average 10% of guys should be having a screen colonoscopy each year. Colonscopists always find something wrong to biopsy. And almost always there is some asymptomatic anterior rectal mucosal change. Mystery solved.