Robot-assisted Laparoscopic Prostatectomy After SpaceOAR Placement

Patients with prostate cancer are offered a wide range of treatments from radiation therapy to chemotherapy to surgery. When giving radiation therapy, SpaceOAR hydrogel has been part of the standard treatment for the last decade to reduce unnecessary radiation exposure to the rectum. In rare cases, SpaceOAR may be placed but the patient cannot go through with radiation. The hydrogel ideally persists in the body for 3months then gets absorbed at 6months.

In this video presentation, we discuss our unique surgical case involving robot-assisted laparoscopic prostatectomy in a patient with SpaceOAR placement for 2months.

A 58-year-old Caucasian male presented with screening prostate-specific antigen 48.47 and a biopsy showed grade group (GG) 3 in three cores, GG2 in one core, and GG1 in five cores. Patient was seen by urology and radiation oncology and initially opted for radiation therapy. He underwent SpaceOAR placement and was given a 6months dose of androgen deprivation therapy. However, during CT planning, small bowel was seen in the radiation field, in proximity to the prostate. As a result, the radiation was thought to be unsafe and he was referred back to urology. We considered options of immediate prostatectomy or waiting 6months until the hydrogel had been fully absorbed. Due to concerns of the hydrogel causing scarring after absorption, we decided to proceed with surgery. The area of SpaceOAR placement created the plane between the prostate and the rectum, however, there was dense scarring around the lateral aspects where the gel had started to absorb. This made the case difficult, but feasible. There were no complications. Final pathology showed pT2N0 with negative margins.

Robot-assisted Radical Prostatectomy after SpaceOAR placement can be safe with good oncologic and functional outcomes. Although it is unknown how the tissues will ultimately heal after full absorption of the gel, it may be prudent to perform the surgery before the hydrogel is absorbed in order to maintain the anatomic planes of dissection.