Ryan Hankins, MD, on rectal spacer utilization and erectile dysfunction

Increased rectal spacer utilization among men receiving radiation therapy for localized prostate cancer is associated with a lower prevalence of erectile dysfunction 4 to 5 years following treatment, according to data presented at the 2025 American Urological Association (AUA) Annual Meeting in Las Vegas, Nevada.¹

Overall, data showed that the utilization of rectal spacers increased over the study period (2016 to 2023), with the proportion of patients receiving a rectal spacer increasing from 2.9% to 18.9%. The investigators found a significant association between counties with higher rectal spacer use and a lower prevalence of erectile dysfunction at 4 to 5 years following the procedure.

Specifically, the authors noted, “A 10-percentage point increase in rectal spacer use at the county level was associated with a 7.7% reduction in ED after 4 years (P < .001) and an 8.4% after 5 years (p=0.006).”

Lead author Ryan A. Hankins, MD, recently sat down with Urology Times® to discuss these findings and their significance for clinical practice. Hankins is a urologist at MedStar Georgetown University Hospital in Washington, DC.

In total, the study included 247,250 patients with prostate cancer who received radiation therapy between 2015 to 2022. The primary outcome measure was the proportion of patients who received a diagnosis of erectile dysfunction between 2016 to 2023.

In addition to the potential to reduce the risk of erectile dysfunction, Hankins also noted that there may be other benefits to receiving a rectal spacer.

He explained, “The primary reason is to help protect the rectum, which runs right behind the prostate, and allow targeted dosing for the prostate to treat prostate cancer. But I think it's important to know that there are other side effects from radiation therapy that may be improved.”

REFERENCES
1. Hankins RA, Sato R, Mehta P, Bhattacharyya S, Ezekwekwu E, Collins S. Real-world U.S. county-level analysis of erectile dysfunction diagnosis following radiation therapy for localized prostate cancer: The impact of rectal spacer utilization. J Urol. 2025;213(5S):e1327. doi:10.1097/01.JU.0001110184.48142.9e.03