A lengthy explanation —> My experience with SpaceOAR (when I was treated during April-May 2021) was positive.

If I were getting external radiation treatments today, I would insist on using a rectal spacer (SpaceOAR, Barrigel, or BioProtect). There would have to be an extraordinarily clear and demonstrated reason not to use it - the rectum does not tolerate radiation well at all.

SpaceOAR Hydrogel was FDA-Approved in 2015. Studies show that SpaceOAR not only reduces rectal radiation dose, but also protects from late GI and GU toxicities, and provides urinary, bowel, and sexual quality-of-life improvement: https://pubmed.ncbi.nlm.nih.gov/34029607/

That 1.3cm-1.5cm additional rectal space (1.5cm-1.7cm for BioProtect) provides “insurance” against rectal injury. If it were me, unless they could assure - not “guarantee” because there are no guarantees - but, simply assure that they would not hit the rectum with radiation, I would insist.

Dr. Rossi talks about it at 4:49:40 during his presentation (https://www.youtube.com/live/WTqPnSRYtW4) at the 2023 mid-year PCRI conference.

My urologist had never used it before - he had always used endorectal balloons. I respectfully told him that didn’t want that. So, I personally reached out to Boston Scientific to find out more about SpaceOAR Hydrogel.

At the time, Boston Scientific was offering one free consultation for patients to call in to discuss SpaceOAR. After that call, I gave them my doctor’s contact information. It took a couple of weeks for the product to come in, but that was ok since we still had to find a urologist to inject it (since my doctor had never done it). We found another urologist in the urology department who had injected it, so we brought him on board,
In the meantime, I read that Boston Scientific had a newer SpaceOAR product called SpaceOAR Vue (FDA-approved in 2019), containing approximately 1% iodine bound to the hydrogel to be more visible under CT scan.

So, after waiting a couple of more weeks for the SpaceOAR Vue product to come in, I had the gel injected. I had no adverse side-effects from the SpaceOAR injection. Yes, there was some bleeding and pain at the injection site (which is to be expected). I’d recommend that you ask them to be generous with the lidocaine (or whatever it is called that they use to numb the areas), both where they penetrate the skin and all the way ahead of where they’re injecting the hydrogel.

If not SpaceOAR, maybe they have access to Barrigel or BioProtect?

> SpaceOAR: https://www.spaceoar.com/find-a-doctor/

> Barrigel: https://barrigel.com/barrigel-physician-locator

> BioProtect: https://bioprotect.com/patient-microsite/

Good luck!