SpaceOAR NHS availibilty

As I reported in my own thread on the subject a few months ago, my oncologist at the Clatterbridge Cancer Centre on the Wirral told me that they're planning to start trialling the procedure there fairly shortly. I can certainly see it becoming a standard part of RT prep for suitable patients in the next few years.

I made the personal decision not to delay my RT by trying to find somewhere to have the procedure carried out (although my insurers had agreed to fund it) after being unable to find somewhere it could be done in the NW of England. As things turned out, I had few side-effects during my RT (although late-onset effects are, of course, still an unknown quantity).

Best wishes,

Chris

Edited by member 30 May 2019 at 07:27  | Reason: Not specified

Looks like it's just a private provider of radiation and other cancer services.

A common difference between NHS and private external beam RT (EBRT) is that NHS typically performs the X-ray imaging for accurate positioning the first 3 times and then once a week thereafter, on the assumption that the prostate doesn't move more than the 5mm overspill margin, whereas private providers image every time, and can have a smaller X-ray overspill margin and therefore less collateral damage. (Maybe thing like bowel contents are not such an issue in this case - I don't know.)

I did a tour of a private provider (different one than you mention) a week ago with the Reading Prostate Cancer Support group. They do about 5 EBRT sessions a day in their LINAC, so they have a lot more time to setup and do the imaging every time (and time to allow us in to see the facility).

I was treated at Addenbrooks, Cambridge - & on every one of my 20 fractions, an Xray scan was done first - it is built into the Therapy machine, you are usually moved very slightly after it, then you get the actual therapy following this.

If I recall correctly, Mount Vernon was in the £3000-4000 range when I was asking a year ago. I didn't get into the detail, because they switched to say I could have it on the NHS trial for free if I was suitable for SpaceOAR, but for medical reasons (being high risk prostate cancer), it was later deemed not suitable for me.

I have bitten the bullet and opted to go for SpaceOAR via my local Hosp Spire it's going to cost £4525, ouch!

I had wanted to go the surgery route but a bleed on the brain, meant that the surgeon wasn't willing to risk it, as I would be inclined 25 degrees head down and blood would be going to my head. So I only really have the Radio Therapy (RT) option (which I didn't want to to do because of the complications that may/can occur especially with the rectum)

So having found out about the spacer I wanted to have that inserted before treatment. I had hoped that I could get it on the NHS but I couldn't find a NHS hospital, at least nearby (Leicestershire) that does it. A bit miffing because if the spacer works as it is claimed (In clinical trials, SpaceOAR has reduced side effects such as bleeding from the rectum, pain, discomfort, and changes in bowel habit by between 60 and 80%. Some recent studies have also shown an improvement in erectile function compared to patients who don't have SpaceOAR.) then I would be possibly saving the NHS from any remedial procedures needed to treat the possible side effects from RT. not to mention the benefit to the patient in terms of quality of life. I have also read that the NHS can provide this service in an article dated May 2019  https://www.england.nhs.uk/2019/05/nhs-funds-tech-to-protect-prostate-cancer-patients-during-radiation-treatment/ 

I wonder if it would be worth getting a petition going to help future PC sufferers opting for RT to have as an option throughout the NHS regardless of area? Perhaps this is something Prostatecanceruk.org could organise and advertise with all it's members and their relatives?

Edited by member 05 Jul 2020 at 13:53  | Reason: added "throughout the NHS regardless of area"

Great you mentioned UCLH. I looked at this before I went down the surgical route. Guys Cancer Centre at London Bridge and Royal Marsden might be worth scoping out too maybe? 

TG

Thanks to all who posted.  I am a 74 year old fit except for the prostate cancer and and getting ready for my radio therapy. I am interested in the SpaceOAR as I already have IBS and don't want to make it worse.  Has anybody had the spacer put in privately and then continued with the NHS radio therapy?  I live in the sticks and my local hospitals are not going to be geared up for the trial and I can't find hospitals that offer it.

Edited by member 07 Dec 2020 at 19:24  | Reason: Not specified

I suspect that even if it is available in your area as part of the innovation fund, the issue right now will be availability of operating theatres and high dependency beds plus the risk of bringing someone into hospital for non-essential surgery. In many areas of the country, all NHS elective surgery is being done at private hospitals to ease pressure and SpaceOar may not be something the relevant private hospital can offer.

The NHS (probably NHS England, but no sure) had 400 SpaceOARs available to use in those patients most likely to benefit, although it's only available in hospitals who have a surgeon trained to install it. Next year, this is expected to be increased to 1400.

If you have IBS, you may be a candidate (it's up to each hospital how they prioritise), but you will need to find a hospital that has the capability of installing it.

EDIT: I'm a year out, it was 400 last year and 1400 this year.

Edited by member 26 Feb 2021 at 08:25  | Reason: Correct dates

Thanks to all who answered.  I have not been able to find which hospitals are offering SpaceOAR and it appears Lincolnshire is not on the list anyway.  I am waiting to find out what the Oncologist's view is of it is if I go down the private route.  As for going in to hospital to get it done, every hospital I have been into in the past six weeks for diagnosis etc has not had a problem and as in Phase 1 of lockdown in March, all the private hospitals were commandeered by the NHS and left largely unused so hopefully there is still space there.  If the NHS had not left me 5 years between PSA tests they would have caught me before mine got locally advanced.  Another case of Postcode lottery unfortunately. Celebrities like Stephen Fry do not have the problem the majority of us do and the profile needs raising so that Prostate Cancer is afforded the same priority as Breast Cancer.  The NHS News release is full of what is essentially "political speak" for how well they are doing in respect of Prostate cancer but the rhetoric does not match the action.  Sadly, as ever it is left to the nurses and doctors to pick up the pieces and they are excellent.

It is the NHS England 'innovation & technology fund' - hospitals can apply for a share if they wish:-

https://www.england.nhs.uk/aac/what-we-do/what-innovations-do-we-support/innovation-and-technology-payment/ 

As I said above, our NHS Trust offered it early doors but have withdrawn from the programme due to lack of take-up from patients 

Edited by member 08 Dec 2020 at 09:43  | Reason: Not specified

I can only tell you of my experience with locally advanced PC. Initially wanted to go down the surgery route, but sepsis from the biopsy and 2 weeks later a bleed on the brain, Has meant that the surgeon was unwilling to risk surgery (in case I had a repeat bleed whilst under). So RT was my only option. Which I didn't fancy due to all the possible side effects (especially to the bowel). I'd read about SpaceOAR, and wanted to go with it. My health authority didn't do the procedure. But a local private one did. So I arranged to go private (£4500 ish), letting the Onc' know that was what I planned. The procedure was done (took a couple of hours or so in total). Felt a little uncomfortable, more strange at first. That quickly went away in a day or so. Had my planning scan 2 weeks later and then started the course of RT. At a meeting with the Onc' halfway through I asked if he knew if the spaceOAR was doing it's job. He said that looking at the figures with regard to % radiation allowed in other nearby organs. I can't remember all the figures but one stuck out. The radiation allowed was 60%, I received 3%, which the spacer had definitely played a part, there were many % less, not all as big a gap as that though. For me I haven't (touch wood) had any bad side effects from the RT, everything seems working as it should (apart from the effects of the hormones).  Next Onc appointment is between Xmas and New year, it will be the first PSA test results since completing my RT. I would encourage any one thinking about RT to get a SpaceOAR it's the best £4500 I've spent. Though would have been better if I could have had it on the NHS.

Hi Andy, for Stereotactic or proton beam my oncologist has said that I personally will not be put on HT.    As for the procedure you're right in that I'm told first of all after the rectal spacer  has been put in then the following day I will have a  mri scan to be sure it is in the correct place and then it will be at least 5 days before any radiotherapy

many thanks for your comments

Thanks Bolinge and others.   I have spent days reading all sorts of reviews plus the comments on here.  Here has been the most up to date and useful.  I have found a consultant who can do both Space and my RT but at some cost, above 19K.  I have my first meeting with him on Tuesday and now have a wealth of questions for him - thanks largely to you. MY real issue is that I can't get advice from my oncologist, even by phone the first consultation is not until 10 Dec - all this is time and life ticking by. My simple question like what are the markers you propose to put in, what type of RA do you use all go unanswered.  Like many of you, my PT is aggressive and advanced but still within the prostate and seminal vesicles.  My PSA was 33.7, which is why I consider that I was left too long between screening.  All available evidence points to 60% of males getting some sort of prostate problem in old age yet that is the very time the system stops screening you.  If that is not agism then I don't know what is.  Notwithstanding all of the above you try to remain positive and crack on.  I just wish I could get more information to guide me and my family's worries. Knowledge dispels fear as they said at parachute school.  Finally, prostate cancer feeds on testosterone (hence the hormone therapy). Left handers produce 20% more testosterone so are we left handers more susceptible?  How many of you are "lefties."

John, there are other rectal spacers and they are not for everyone. The NHS funding for rectal spacers will run out in March 21, currently NHS England have not decided if they are going to move ahead with anymore funding for this scheme currently. If they do decided to move ahead they will not only consider SpaceOAR as there is a new spacer on the market that is the second generation of these rectal spacers it is called Barrigel. This product is supported by the main AHSN involved with the Innovation funding for spacers in the NHS and is fully acknowledged by NHS England as the alternative to SpaceOAR. However the manufacture of SpaceOAR will have you believe their's is the only product available when there is actually three types available in the UK currently. One is currently being trialled in the private sector but requires surgical intervention to have it put in, it is called Bio Protect, this is mainly being use in proton treatment. The second is Barrigel, Barrigel is put in with LA in a day case unit and finally there is the one everyone knows about called SpaceOAR.

All of these spacers are NOT currently NICE approved however there is NICE guidance available in the IPG590, this is what the clinical teams use when deciding how they are to move forward. I believe that the second two rectal spacers are currently awaiting NICE approval, that I do not believe will be coming forward anytime soon thanks to COVID, however watch this space.

The Barrigel rectal spacer is the only one that is indicated to be used on Prostate Cancer patients up to T3B, SpaceOAR is only indicated up to T2 anything past this the doctors decision. Barrigel will stay in place for around 12 months whereas SpaceOAR will stay in place for about 6 months. the main difference between the two is one is a glue the other is a dermal filler, also the Barrigel product is fully reversible, whereas with SpaceOAR it doesn't come out.

To have a rectal spacer in the NHS a majority of the current NHS sites will undertake this under local Anaesthetic just like a prostate biopsy is undertaken. The main reason for this is cost, also theatre time in the NHS is very sought after and they cannot always get this.

my advise would be do your research on the spacers as their is a lot of inaccuracies out there from PR teams creating spin on their product that carries incorrect information. The best example of this is the recent article in the Mail on Sunday, this article is full of inaccuracies. Also speak to your doctors and nurses they are the professionals when is comes to your treatment options, be guided by them and do your own research on what is best for yourself.

I believe that the Prostate Support group Tackle are to run an article on the Barrigel product very soon..watch this space.

Good Luck with your treatment! 

you are very welcome