Safety and Patient Selection for Rectal Spacer Use

In this installment, Martin T. King, MD, PhD, reviews the trial's safety findings, noting that there were no periprocedural adverse events associated with spacer placement, and no adverse events from placement that led to acute or late toxicity within the study.1

Asked how reassuring the long-term safety data are for clinicians considering routine spacer use, he says he finds them quite reassuring. He points to a growing body of long-term, real-world safety data accumulating across rectal spacers more broadly, while still encouraging clinicians to remain vigilant and open to new information as it emerges, and to be trained to recognize any concerning findings after spacer placement. Overall, he says the long-term safety profile of the hyaluronic acid product gives him confidence in its use. When asked directly whether any safety signals warrant continued surveillance or further study, he says he did not encounter any in this trial.

He then addresses how these data should shape patient selection. He explains that the trial supports rectal spacer use in patients who meet the study's eligibility criteria, specifically those with low- or intermediate-risk prostate cancer who are interested in minimizing their risk of GI toxicity. In his view, this helps define a specific population for whom there is now high-level evidence of benefit from rectal spacing, giving clinicians a clearer basis for recommending the intervention to appropriate candidates who share those characteristics, rather than applying rectal spacing broadly across every patient receiving prostate radiotherapy regardless of risk group or personal priorities around GI adverse events.

In the next episode, "Broader Adoption and Future Research in Rectal Spacing," King closes by looking at where rectal spacer research could go next, from new radiation techniques to open questions about long-term quality of life.