Standardization of Rectal Spacer Protocols for Prostate Cancer: Timing and Collaborative Care

In this segment, the panel outlines the complementary roles of urologists and radiation oncologists in recommending, evaluating, and placing rectal spacers for prostate cancer radiotherapy. The discussion emphasizes that urologists typically lead diagnostic work—PSA testing, MRI review, and biopsy—which also helps determine whether a patient is an appropriate candidate for spacer placement based on anatomical considerations such as posterior extracapsular extension. Radiation oncologists contribute critical insight into treatment planning, spacer safety, and how an individual patient’s anatomy, comorbidities, and preferences influence the decision to use a spacer. Together, they describe the importance of real-time communication, shared MRI review, and mutual feedback to optimize placement quality and minimize risk. The segment also highlights scenarios in which spacers may be omitted, the risk differences among spacer types, and how timing should be coordinated with hormone therapy, simulation imaging, and radiation start dates. Ultimately, their collaborative model supports safer treatments, fewer rectal side effects, and better patient outcomes.