Rectal Spacer Technologies and Placement Challenges in Prostate Cancer Care

In this segment, the expert faculty provide a detailed comparison of the major rectal spacer technologies—Barrigel, SpaceOAR, and BioProtect—highlighting how their material properties influence placement, safety, and treatment outcomes. They explain that Barrigel, made of hyaluronic acid, is pre-formed and fully sculptable, allowing precise, real-time adjustments under ultrasound guidance without time or pressure constraints. In contrast, SpaceOAR uses PEG-based liquids that polymerize rapidly, limiting repositioning and increasing the risk of rectal wall infiltration, while BioProtect employs a resorbable balloon that lacks reversibility and can be more restrictive in challenging anatomies. They emphasize the clinical value of reversibility with Barrigel, particularly when seeking aggressive apical spacing where anatomical planes are minimal. The physicians discuss how spacer stability, visibility on CT, and the ability to correct or dissolve misplaced product affect radiotherapy planning, risk of complications, and decisions about whether to proceed or delay treatment.