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Rectal spacers are a game-changer in reducing the effect of toxicity to healthy tissues such as the bowel. This simple device is inserted between the rectum and the prostate to temporarily move the anterior rectal wall further away from the prostate. The aim is to reduce the amount of radiation delivered to the rectum and limit toxicity, therefore reducing bowel, urinary and sexual function related side effects.
The spacer lasts for the entire course of prostate radiotherapy treatment and is absorbed and eliminated naturally by the patient’s body over time.
How do spacers work?
The spacer creates space between the prostate gland and rectum, enabling a more accurately targeted radiation dose to the prostate while avoiding unnecessary radiation to healthy organs and tissue.
What are the benefits?
Studies have shown that using spacers in men undergoing radiotherapy for prostate cancer is safe and effective and has been NICE-approved since 2017. By creating perirectal space, the spacer reduces rectal irradiation and results in fewer patient-reported declines in bowel, urinary and sexual function, and improves quality of life (QOL).[2-7]
How are spacers implanted?
A spacer insertion is a minimally invasive procedure that takes around 30 minutes.
Our urologists use a needle to insert the spacer between the prostate and the rectum using an ultrasound-guided transperineal approach. The spacer stays in position during the radiotherapy treatment cycle then naturally biodegrades to be absorbed and eliminated naturally by the body over time.
The procedure is routinely performed under local anaesthetic at a number of our outpatient centres as a safe and convenient alternative to having the insertion under general anaesthetic within a hospital environment.
We accept referrals for patients receiving prostate radiotherapy treatment within the GenesisCare network.
Insertions are also available as a day case procedure, performed under general anaesthetic by urologists within the GenesisCare network at a number of our national partner hospitals, located through the UK
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GenesisCare is a global organisation with over 440 cancer centres throughout the UK, USA, Australia and Spain. In the UK we specialise in advanced and innovative cancer diagnostics and treatments, and collaborate with health professionals who share our vision of enabling fast access to world-class cancer care.
We work in partnership with our consultants to build a strong governance framework and to be the first to introduce many new cancer treatments safely and effectively. Our strategy is to invest early in new evidence-based treatments and modalities that hold potential for improved life outcomes.
We are a patient-first organisation and aim to provide exceptional care in everything we do. Many of our centres are rated good by the CQC and carry the Macmillan Quality Environment Mark (MQEM).
- National Institute for Health and Care Excellence (2017) Biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer (Interventional procedures guidance [IPG590]). Available at: https://www.nice.org.uk/guidance/ipg590 [Accessed 14 October 2020]
- Mariados N, Sylvester J et al (2015). Hydrogel Spacer Prospective Multicenter Randomized Controlled Pivotal Trial: Dosimetric and Clinical Effects of Perirectal Spacer Application in Men Undergoing Prostate Image Guided Intensity Modulated Radiation Therapy. International Journal of Radiation Oncology Biology Physics.92 (5) 971-977.
- Uhl M, Herfarth K et al (2014). Absorbable hydrogel spacer use in men undergoing prostate cancer radiotherapy: 12 month toxicity and proctoscopy results of a prospective multicenter phase II trial. Radiation oncology 9:96. Song DY, Herfarth KK et al (2013). A multi-institutional clinical trial of rectal dose reduction via injected polyethylene-glycol hydrogel during intensity modulated radiation therapy for prostate cancer: Analysis of dosimetric outcomes. International Journal of Radiation Oncology Biology Physics.87 (1) 81-87.
- Wolf F, Gaisberger C et al (2015). Comparison of two different rectal spacers in prostate cancer external beam radiotherapy in terms of rectal sparing and volume consistency. Radiotherapy & Oncology 116 (2) 221- 225.
- Gez E, Cytron S et al (2013). Application of an interstitial and biodegradable balloon system for prostate-rectum separation during prostate cancer radiotherapy: a prospective multi-center study. Radiation Oncology 2013, 8:96
- Chapet O, Decullier E et al (2015). Prostate hypofractionated radiation therapy with injection of hyaluronic acid: Acute toxicities in a phase 2 study. International Journal of Radiation Oncology Biology Physics.91 (4) 730-736.
- Noyes WR, Hosford CC et al (2012). Human collagen injections to reduce rectal dose during radiotherapy. International Journal of Radiation Oncology Biology Physics. 82: 1918-1922.