Tag Archive for: Radiation for prostate cancer

Prostate cancer, Movember and the moustache: a conversation worth having

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Each November, a moustache can do more than change a face. It can open a conversation that might encourage someone to learn their risk, ask about testing or support a person affected by prostate cancer.

Movember is a good time to talk about prostate cancer, but the message matters all year. The aim is not to alarm every man or suggest that everyone needs the same test. It is to make sure people know the facts and can make an informed decision with their doctor.

Prostate cancer in Australia

Prostate cancer is common. The Australian Institute of Health and Welfare (AIHW) estimated that around 29,000 men would be diagnosed in 2025, making it the most commonly diagnosed cancer in Australian men and accounting for about 30% of cancers diagnosed in men that year. These are projected figures, not a final count. Around 1 in 5 men are expected to be diagnosed with prostate cancer during their lifetime.

The outlook is often very good: the AIHW reports a 96% five-year relative survival rate for prostate cancer diagnosed in 2017–2021. That is a population statistic, not a prediction for any one person. Prostate cancers vary: some grow slowly and may never cause harm, while others can be aggressive and need timely treatment. Early assessment can help identify cancers that are more likely to matter, while careful risk assessment helps avoid unnecessary tests and treatment.

What does Movember mean?

Movember began with a simple idea: grow a moustache, raise funds and get people talking about men’s health. It has grown into a global movement supporting men’s health, including prostate cancer, testicular cancer, mental health and physical activity.

The moustache is a friendly, visible conversation starter. Someone may ask, “Why the Mo?” and that gives you a chance to mention prostate cancer, ask a friend whether he knows his family history, or check in with someone who is going through diagnosis or treatment. A moustache cannot detect cancer, and growing one does not replace medical advice. Its value is in helping make a sometimes awkward subject easier to raise.

How is prostate cancer found?

Prostate cancer often causes no symptoms in its early stages. Urinary symptoms such as a weaker stream, needing to urinate more often or difficulty starting are common with ageing and an enlarged prostate, and do not by themselves mean cancer. Blood in the urine or semen, persistent pain, or a new urinary problem should be discussed with a doctor.

The first step in early detection is usually a conversation about personal risk and the possible benefits and downsides of testing. A prostate-specific antigen (PSA) blood test measures a protein made by the prostate. PSA can rise for reasons other than cancer, including prostate enlargement, infection or inflammation. A raised result is not a diagnosis, and a low result does not rule out every cancer.

Australia’s updated national early-detection guidelines, approved by the National Health and Medical Research Council in May 2026, recommend discussing individual risks, preferences, benefits and possible harms before starting PSA testing. For men who choose testing, the guidelines recommend offering it every two years from age 50 to 69 for those not at higher risk, and from age 45 for those at higher risk. Higher risk includes a relevant family history, a confirmed BRCA2 gene mutation or Black sub-Saharan ancestry. Men aged 70 and over should discuss whether to continue testing in light of their health and preferences. These are discussion points, not a substitute for individual medical advice.

If a PSA result is higher than expected, a doctor may repeat the test and consider other information, such as age, symptoms, family history and examination findings. A urologist may recommend a prostate MRI to help decide whether a biopsy is appropriate and, if so, where to take samples. A biopsy is currently the test that confirms a diagnosis and provides information about the cancer’s grade. Not everyone with an elevated PSA needs a biopsy, and no test is perfect. If cancer is found, the next steps depend on its grade and stage, the person’s health and their preferences; some lower-risk cancers can be monitored with active surveillance.

Make November a reason to check in

This November, consider wearing blue when you walk, jog, run or volunteer at your local parkrun. Invite a friend or family member to join you. It is a simple way to show support, start a conversation and make space for men’s health alongside the usual weekend catch-up. This is a community invitation, not a claim that parkrun is running an official Movember campaign.

If you are unsure whether PSA testing is right for you, speak with your GP. Mention your age, family history and any symptoms, and ask what a result could mean and what the next steps might be. If someone close to you has prostate cancer, listening and offering to go with them to an appointment can be a practical form of support.

Grow a Mo, wear blue, or simply start the conversation. The moustache is the prompt; informed choices and looking out for one another are the point.

This article provides general information and is not a substitute for advice from your doctor. Testing decisions should be made with a health professional who can consider your personal circumstances.

References and further information

  1. Australian Institute of Health and Welfare. Cancer data in Australia: Overview of cancer in Australia, 2025.
  2. Australian Institute of Health and Welfare. Cancer outcomes improving overall.
  3. Prostate Cancer Foundation of Australia. PSA testing and the 2026 Australian early-detection guidelines.
  4. Prostate Cancer Foundation of Australia. Diagnosis of prostate cancer.
  5. Movember. About Movember.
  6. parkrun Australia. Find a parkrun event.

Movember, King Charles and the Prostate: Why Men Shouldn’t Ignore Their Health

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Movember, King Charles and the Prostate: Why Men Shouldn’t Ignore Their Health

A moustache can start a conversation. A conversation can sometimes save a life.

Every November, moustaches begin appearing on faces around Australia and across the world. Some are magnificent. Some are questionable. Some probably deserve their own urological assessment.

But behind the facial hair lies an important message.

Movember is about getting men talking about their health.

What began in Melbourne in 2003 with 30 men growing moustaches has developed into an international men’s health movement focusing particularly on prostate cancer, testicular cancer, mental health and suicide prevention. Movember reports that it has funded more than 1,320 men’s health projects around the world.

And few recent stories demonstrate the importance of men paying attention to their health better than that of King Charles III.

First, an important clarification: King Charles does NOT have prostate cancer

This point has frequently been confused in media and social-media discussions.

In January 2024, Buckingham Palace announced that King Charles was receiving treatment for an enlarged prostate.

This was benign prostatic enlargement, commonly called benign prostatic hyperplasia or BPH. It is extremely common as men get older and is not prostate cancer.

The King underwent a planned hospital procedure for his enlarged prostate.

During this episode of care, however, doctors identified a separate abnormality. Further investigations subsequently diagnosed a form of cancer.

Buckingham Palace specifically confirmed that the King’s cancer was not prostate cancer. The precise type of cancer has remained private.

That distinction matters.

But so does what happened next.

A prostate problem led to something else being discovered

The King’s story provides an interesting lesson for men’s health.

He sought medical attention for a prostate problem.

He underwent investigation and treatment.

During that process, doctors discovered another potentially important medical condition.

In February 2024 Buckingham Palace announced that the King had begun a programme of regular cancer treatments and temporarily reduced his public-facing duties.

By April 2024, following treatment and recuperation, he was able to return to public-facing duties.

The exact cancer treatment has never been publicly disclosed, and it would therefore be inappropriate to speculate whether he has received surgery, radiotherapy, chemotherapy, immunotherapy or another form of treatment.

More recently, the King has continued to speak publicly about his cancer experience. In December 2025 he announced that, following early diagnosis, treatment and adherence to medical advice, his treatment schedule could be reduced in the following year.

In June 2026 he and Queen Camilla hosted a reception marking the 125th anniversary of Cancer Research UK, of which the King has been Patron since 2024.

His message has increasingly centered on a simple theme:

Early diagnosis matters.

The other royal problem: an enlarged prostate

For a urologist, the first part of the King’s story is equally important.

An enlarged prostate is extraordinarily common.

As the prostate enlarges, it can compress the urethra and interfere with the passage of urine.

Men may notice:

  • a slower urinary stream
  • difficulty starting urination
  • stopping and starting
  • straining
  • feeling that the bladder has not emptied completely
  • getting up several times during the night
  • urgency or frequency
  • occasionally an inability to pass urine at all.

These symptoms do not automatically mean prostate cancer.

Most commonly they are associated with benign prostate enlargement.

But that does not mean they should simply be accepted as part of getting older.

“It’s probably just my prostate”

Possibly.

But that is precisely why it is worth having it checked.

Assessment of urinary symptoms may include a discussion about symptoms and medications, examination, urine testing, kidney function, PSA testing where appropriate, urinary flow measurement, ultrasound assessment of bladder emptying and occasionally further investigations.

The objective is not simply to find prostate cancer.

It is to work out why the urinary system is behaving differently.

What about prostate cancer?

This is where Movember becomes particularly relevant.

Prostate cancer remains the most commonly diagnosed cancer in Australian men. Australian Institute of Health and Welfare data indicate that prostate cancer accounted for approximately 28% of cancers diagnosed in Australian males in 2024.

AIHW’s updated projections estimate approximately 26,397 prostate cancer diagnoses in Australia during 2026, although it is important to recognise that this is a projection rather than a final observed case count.

Movember estimates that approximately one in five Australian men will be diagnosed with prostate cancer during their lifetime.

And there is another important difference between prostate cancer and benign enlargement:

Early prostate cancer frequently causes no urinary symptoms at all.

Waiting until something hurts or the urine flow deteriorates is therefore not an effective prostate cancer detection strategy.

The PSA conversation

A PSA blood test can help identify men who may require further investigation for prostate cancer.

But PSA is not simply a “cancer test”.

PSA can be elevated for several reasons, including:

  • benign prostate enlargement
  • prostatitis or inflammation
  • urinary infection
  • recent instrumentation
  • urinary retention
  • and prostate cancer.

An abnormal PSA therefore does not automatically mean cancer.

Similarly, decisions about PSA testing should consider a man’s age, family history, previous PSA results, general health and individual risk factors.

The important step is having the conversation with your GP or urologist rather than avoiding the subject altogether.

And if prostate cancer is found?

Modern prostate cancer treatment is no longer a simple choice between “operate” and “do nothing”.

Depending upon the PSA, MRI findings, biopsy grade, tumour volume, stage, age and general health of the patient, options may include:

Active surveillance for suitable low-risk disease.

Robotic-assisted radical prostatectomy for appropriate localised cancers.

Radiation therapy, sometimes combined with hormonal treatment.

Focal therapies in carefully selected patients and specialised settings.

Androgen deprivation and newer androgen-receptor targeted treatments for more advanced disease.

Chemotherapy and radioligand therapies for selected advanced cancers.

The right treatment is increasingly personalised to both the biology of the cancer and the priorities of the man sitting in front of us.

Treatment is not only about surviving cancer

This is another area in which organisations such as Movember have made an important contribution.

Men understandably want their cancer controlled.

But they also care about what happens afterwards.

Will I leak urine?

Will I still have erections?

What happens to ejaculation and orgasm?

Can I continue working?

How will treatment affect my relationship?

Will I still feel like myself?

Movember has invested not only in prostate cancer research but also in projects examining quality of life, urinary function, sexual function and outcomes following treatment. The Prostate Cancer Outcomes Registry Australia and New Zealand, for example, collects patient-reported outcomes including urinary, bowel and sexual function after prostate cancer diagnosis and treatment.

These aren’t embarrassing side issues.

They are part of treating the whole man.

So what does King Charles have to do with Movember?

Quite a lot, despite the fact that he does not have prostate cancer.

His story began with something millions of older men experience:

an enlarged prostate.

Instead of ignoring it, he sought treatment.

That interaction with the healthcare system resulted in another cancer being discovered.

And by publicly announcing his prostate treatment and subsequent cancer diagnosis, the King did something particularly useful for men’s health:

he made it easier to talk about it.

That is essentially what Movember has been trying to achieve for more than two decades.

A moustache is simply the billboard.

The conversation is the important bit.

My Movember message to men

If your urinary stream isn’t what it used to be, get it checked.

If you’re getting up repeatedly during the night, ask why.

If you’re struggling with erections, don’t be embarrassed to mention it.

If you notice a testicular lump, don’t wait.

If prostate cancer runs in your family, discuss your individual risk.

And if you’ve been putting off that conversation about PSA testing, perhaps Movember is a good time to have it.

Men are remarkably good at servicing cars, replacing batteries, checking tyre pressures and investigating strange noises coming from engines.

We are sometimes considerably less enthusiastic when the strange noise is coming from ourselves.

This Movember, grow the moustache if you wish.

But more importantly:

Have the conversation.
Know your prostate.
Know your risk.
And don’t ignore a change in your body simply because it’s embarrassing to talk about.

Your prostate may be small.

Its ability to cause trouble is disproportionately ambitious.

References and further reading

  1. The Royal Family. A Statement from Buckingham Palace. 5 February 2024. Buckingham Palace confirmed that a separate cancer was discovered during treatment for benign prostate enlargement.
  2. The Royal Family. The King returns to public-facing duties. April 2024.
  3. The Royal Family. A message from The King in support of Stand Up To Cancer. December 2025.
  4. The Royal Family. The King and Queen host a reception for Cancer Research UK. June 2026.
  5. Australian Institute of Health and Welfare. The health of men in Australia. Prostate cancer statistics and Australian cancer burden.
  6. Australian Institute of Health and Welfare. Cancer data in Australia: Prostate cancer projection method changes and updated long-term projections. Updated July 2026.
  7. Movember. Prostate Cancer: Prostate Cancer Action, Innovation & Collaboration. Australian prostate cancer statistics and research programs.
  8. Movember. Our Story. History of the Movember movement from Melbourne in 2003.
  9. Movember. Prostate Cancer Outcomes Registry Australia and New Zealand. Patient outcomes and quality-of-life research.

Medical disclaimer

This article provides general information and should not replace individual medical assessment. Urinary symptoms, an abnormal PSA or concerns about prostate cancer should be discussed with your GP or urologist.

Prostate cancer with kidney failure: is surgery, focal therapy or radiation the right choice?

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A patient guide by Dr Jo Schoeman

A diagnosis of prostate cancer is unsettling. Having chronic kidney disease or needing dialysis can make treatment decisions feel even harder. The reassuring point is that kidney failure does not automatically rule out treatment. The best choice depends on the cancer, the degree of kidney impairment, other medical conditions and, crucially, whether a kidney transplant is planned.

What does Gleason 3+4 mean?

Gleason 3+4=7 is Grade Group 2 prostate cancer. Most of the sampled tumour has pattern 3, with a smaller component of pattern 4. It is generally less concerning than Gleason 4+3=7, but “3+4” alone cannot tell us whether immediate treatment is needed.

I would review the PSA and PSA density, examination, MRI findings, number and length of positive biopsy cores, percentage of pattern 4, any cribriform or intraductal cancer, and whether disease is confined to the prostate. Kidney function, dialysis schedule, life expectancy and transplant eligibility are considered alongside these findings. Some men have favourable intermediate-risk cancer; others have features that make definitive treatment more appropriate. Staging scans are selected according to overall risk rather than biopsy grade alone. [1,2]

Could active surveillance be reasonable?

Yes, for selected men with small-volume, favourable Grade Group 2 cancer. Surveillance means scheduled PSA tests, clinical review, MRI where useful and repeat biopsy when indicated. It keeps treatment available if the cancer changes. It is a particularly meaningful option when another serious illness makes the harms of immediate treatment more likely to outweigh its benefit. It does, however, require a patient who can attend follow-up and accepts a small increased risk of progression compared with immediate treatment. [1,2]

If kidney disease or other illnesses substantially limit life expectancy, watchful waiting may be more appropriate: care focuses on symptoms rather than routine testing intended to trigger curative treatment. This is a separate decision from active surveillance. [1]

Can radical prostatectomy or robotic surgery be performed?

Often, yes. Chronic kidney disease and dialysis are not automatic contraindications to radical prostatectomy. Robotic assisted surgery may offer less blood loss and a shorter hospital stay than open surgery in selected patients, but it still involves general anaesthesia, abdominal insufflation and a head-down operating position. Advanced kidney disease increases the importance of planning for bleeding, infection, fluid and electrolyte balance, medication dosing and postoperative kidney injury. Population studies find higher complication rates in patients with chronic kidney disease, particularly advanced disease; individual risk varies considerably. [3,4]

Before an operation I would coordinate with the nephrologist, anaesthetist and, where relevant, dialysis team. We would assess cardiovascular health, haemoglobin, potassium, anticoagulants, residual kidney function and the timing of dialysis. Surgery also carries the usual risks of urinary leakage or incontinence, erectile dysfunction, infertility, blood clots and possible need for further cancer treatment. Whether a robotic approach is feasible depends on the patient and the surgical team; it is not automatically a safer choice for every person with kidney failure. [1,3,4]

Is focal therapy a better option?

Not simply because the kidneys are failing. Focal therapy treats the visible cancer-bearing portion of the prostate, using a technique such as focused ultrasound, cryotherapy or another ablative method. It may appeal to men hoping to reduce urinary or sexual side effects, but the cancer can be present elsewhere in the gland, and longer-term cancer control is less certain than for established whole-gland treatments. Further MRI, biopsies and sometimes repeat treatment are necessary.

The AUA/ASTRO guideline notes a lack of high-quality comparisons with surgery, radiation and surveillance. European guidance restricts focal treatment to settings with careful prospective follow-up, such as a trial or registry. Kidney disease alone does not establish that focal treatment is preferable. In a suitable patient it can be discussed with a specialist who explains uncertainty, access, costs and a clear follow-up plan. [1,2]

Is radiotherapy an option?

Yes. External beam radiotherapy avoids major surgery and usually does not expose the kidneys directly when treating a prostate confined to the pelvis. Options include moderately shortened courses and, for selected men, more condensed schedules or brachytherapy. The radiation oncologist will tailor treatment to the cancer and urinary function. Depending on whether the disease is favourable or unfavourable intermediate risk, a course of androgen deprivation therapy (ADT) may also be advised; ADT has its own effects on energy, muscle, bone and metabolic health. [1,2]

Radiotherapy may cause temporary urinary frequency, burning or bowel upset; longer-term urinary, bowel or erectile effects are also possible. Existing urinary obstruction and kidney transplant anatomy can change planning. In a transplant recipient, the graft and ureter may sit in the pelvis, so radiation dose constraints require particular attention. Dialysis, by itself, does not make prostate radiation impossible. [1,2]

What if a kidney transplant is planned?

This is a central part of the discussion. A transplant team may need to know whether the cancer is under surveillance or has been treated, its estimated risk of progression and the proposed follow-up. The presence of prostate cancer does not automatically mean that transplantation must wait for a fixed number of years; transplant eligibility is individual and should be discussed directly with the transplant team. A transplanted kidney in the pelvis also affects the planning of later pelvic surgery or radiotherapy. [5]

How do we decide?

Option When it may fit Main trade-off
Active surveillance Low-volume, favourable Grade Group 2 disease Regular testing and a possibility of later treatment
Robotic radical prostatectomy Fit patient seeking definitive local treatment Anaesthetic and surgical risks, with continence and erectile side effects
Radiotherapy Patient seeking definitive treatment without prostate removal Urinary, bowel and sexual effects; ADT may be needed
Focal therapy Carefully selected patient after discussion of uncertainty Less established long-term cancer control and ongoing biopsies
Watchful waiting Limited life expectancy or major competing health risks Treats symptoms if they arise rather than aiming for cure

There is no universal winner between robotic surgery and radiation for Gleason 3+4 cancer with kidney failure. A multidisciplinary discussion involving urology, radiation oncology, nephrology and the transplant team, if applicable, helps align cancer control with kidney health and the patient’s priorities.

This article offers general information and cannot determine treatment for an individual patient. Decisions require review of the pathology, imaging, kidney function and overall health.

References

  1. European Association of Urology. EAU Guidelines on Prostate Cancer: Treatment. Accessed September 2026.
  2. American Urological Association and American Society for Radiation Oncology. Clinically Localized Prostate Cancer Guideline. 2022.
  3. Post-surgical outcomes of patients with chronic kidney disease and end stage renal disease undergoing radical prostatectomy: 10-year results from the US National Inpatient Sample. 2019.
  4. The Effect of Chronic Kidney Disease on Adverse In-Hospital Outcomes at Radical Prostatectomy. 2025.
  5. Kidney Disease: Improving Global Outcomes. KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. 2020.

Protecting the Rectum During Prostate Radiotherapy: A Patient Guide

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Radiotherapy is an established treatment for many men with prostate cancer. Modern planning and image-guidance techniques can direct radiation accurately, but the prostate lies immediately in front of the rectum. Because the two organs are so close, part of the rectal wall may receive radiation during treatment.

Radiation teams use several methods to limit exposure to surrounding healthy tissue. For selected patients, one option is to place a temporary biodegradable material between the prostate and rectum before radiotherapy planning.

This article explains why bowel effects occur, how rectal spacing works, its possible benefits and limitations, and the questions patients should discuss with their treating team. It does not recommend a particular product, device or brand.

Why can prostate radiotherapy affect the bowel?

The front wall of the rectum normally sits very close to the back of the prostate. Radiation directed at the prostate may therefore also reach a small amount of nearby rectal tissue.

Possible bowel effects during or after radiotherapy include:

  • increased bowel frequency
  • urgency
  • loose stools or diarrhoea
  • mucus discharge
  • rectal discomfort
  • bleeding
  • inflammation known as radiation proctitis

Many bowel symptoms are mild and settle after treatment, but some develop later or persist. Risk varies with the radiation technique, dose, fractionation schedule, individual anatomy, bowel health, medicines and previous pelvic treatment.

Rectal bleeding after radiotherapy should not automatically be attributed to radiation. Other causes, including haemorrhoids, polyps, inflammatory bowel disease and bowel cancer, may require investigation.

How is the rectum protected?

Protection begins with careful radiotherapy planning rather than with a spacer alone. Strategies may include:

  • intensity-modulated or volumetric-modulated radiotherapy
  • image guidance before and during treatment
  • accurate bladder and bowel preparation
  • management of rectal gas or stool
  • individualised dose constraints
  • limiting movement of the prostate
  • selecting an appropriate radiation schedule
  • a temporary rectal spacer in selected patients

A spacer is therefore an additional planning tool, not a substitute for high-quality radiation oncology.

What is a rectal spacer?

A rectal spacer is a temporary biodegradable material placed into the tissue plane between the prostate and the anterior rectal wall. Increasing this distance may reduce the radiation dose received by the rectum.

Materials used in currently available spacer systems include:

  • polyethylene-glycol hydrogel
  • stabilised hyaluronic-acid gel

These materials have different handling and imaging characteristics. They should not be assumed to have identical evidence, contraindications or safety profiles.

A spacer does not treat prostate cancer. Its role is to alter the anatomy temporarily while radiation treats the cancer.

Do all men having prostate radiotherapy need a spacer?

No. Many patients can receive carefully planned radiotherapy without one.

Potential benefit depends on factors such as:

  • the natural distance between the prostate and rectum
  • prostate size and shape
  • tumour position and extent
  • radiation dose and treatment schedule
  • the ability to meet rectal dose constraints without a spacer
  • previous prostate or pelvic procedures
  • bowel disease
  • bleeding risk and relevant medicines
  • whether pelvic lymph nodes are also being treated
  • local expertise and access

For some patients, the predicted reduction in rectal dose may be clinically meaningful. For others, the benefit may be small, uncertain or outweighed by the insertion risk.

The decision is usually made with the radiation oncologist. A urologist or another trained proceduralist may also be involved.

What does the evidence show?

Clinical studies of biodegradable rectal spacers generally show that increasing the distance between the prostate and rectum can reduce the radiation dose delivered to parts of the rectal wall.

A multicentre randomised trial involving 201 men receiving hypofractionated prostate radiotherapy evaluated a hyaluronic-acid spacer. The study reported improved rectal dosimetry and fewer acute grade 2 or worse gastrointestinal adverse events in the spacer group than in the control group.

These findings are relevant but require context:

  • dosimetric improvement does not guarantee that an individual patient will avoid bowel symptoms
  • trial participants and treatment protocols may differ from patients treated in routine practice
  • evidence for short-term bowel outcomes is stronger than evidence for some long-term outcomes
  • results for one spacer material or insertion technique should not automatically be applied to another
  • operator experience and correct placement affect both benefit and risk

Patients should ask how the published evidence applies to their planned radiotherapy technique and personal anatomy.

How is a spacer inserted?

The procedure is generally performed before radiotherapy planning.

Under ultrasound guidance, a needle is passed through the perineum—the skin between the scrotum and anus—into the potential space between the prostate and rectum. The tissue plane is checked carefully, and the spacer material is then introduced while its position is monitored.

Depending on the patient and treating centre, the procedure may use:

  • local anaesthesia
  • sedation
  • general anaesthesia

Fiducial markers used to help target radiotherapy may sometimes be inserted during the same procedure.

The exact preparation, antibiotic policy, management of anticoagulants and post-procedure care vary. Patients should follow the instructions given by their treating team.

Why does correct placement matter?

The spacer needs to create suitable separation along the part of the rectum closest to the planned radiation target. Too little separation, marked asymmetry or injection into the wrong tissue plane may reduce the expected dosimetric benefit.

Incorrect placement may also injure the rectal wall, prostate, urethra, bladder or nearby blood vessels. Training, real-time imaging, careful patient selection and recognition of abnormal anatomy are therefore important.

Some hyaluronic-acid materials can be broken down with an enzyme if significant malposition is recognised. This does not make incorrect placement harmless or remove the need for prevention, prompt assessment and appropriate management.

Who may be unsuitable?

Suitability depends on the particular device instructions, the patient’s anatomy and the clinical situation. Reasons to avoid or reconsider insertion may include:

  • infection or inflammation near the proposed injection site
  • inability to identify a safe tissue plane
  • tumour extending into the space behind the prostate
  • extensive scarring from previous surgery or treatment
  • significant rectal or anorectal disease
  • uncorrected bleeding disorder
  • anticoagulant or antiplatelet therapy that cannot be managed safely
  • allergy or hypersensitivity relevant to the proposed material
  • significant immunosuppression
  • a situation in which the expected dosimetric benefit is minimal

The approved Australian instructions for use for the exact device should be checked by the treating clinician.

Anticoagulant and antiplatelet medicines must not be stopped without advice from the clinician who manages them. Interrupting these medicines can cause stroke, heart attack, thrombosis or other serious harm.

Possible short-term effects

Temporary effects may include:

  • perineal discomfort or bruising
  • minor bleeding
  • a sensation of rectal fullness
  • discomfort when opening the bowels
  • urinary frequency or burning
  • a weaker urinary stream
  • constipation

The pattern and duration vary. New, severe or worsening symptoms require clinical review.

Uncommon but important complications

Spacer insertion is invasive and can cause serious complications, even when performed carefully.

Reported or plausible complications include:

  • infection, prostatitis or pelvic abscess
  • bleeding or haematoma
  • urinary retention
  • significant rectal or pelvic pain
  • spacer malposition or migration
  • injection into the rectal wall, prostate or another unintended site
  • injury to the urethra, bladder, rectum or blood vessel
  • rectal ulceration or tissue necrosis
  • embolic or vascular complications
  • fistula formation
  • need for further treatment, hospital admission or surgery

Severe pain, fever, difficulty passing urine, heavy bleeding, worsening bowel symptoms or feeling systemically unwell after the procedure should be assessed promptly.

What happens to the spacer?

Biodegradable spacers are intended to remain during the radiotherapy period and then gradually break down and be absorbed.

The expected duration and degradation process depend on the material. A second operation is not normally required solely to remove an appropriately placed biodegradable spacer.

Different spacer materials

The choice should not be reduced to a promotional comparison between brand names. Relevant clinical differences may include:

Consideration Hyaluronic-acid gel Polyethylene-glycol hydrogel
Primary purpose Temporary prostate–rectum separation Temporary prostate–rectum separation
Typical placement Transperineal, image-guided Transperineal, image-guided
Biodegradable Yes Yes
Handling Deposited and shaped during injection Forms a hydrogel after delivery
Imaging Visibility depends on material and imaging method Some formulations are designed for greater CT visibility
Evidence Randomised and observational studies are available Randomised, prospective and observational studies are available
Key limitation Insertion-related risk and dependence on correct placement Insertion-related risk and dependence on correct placement

This table is descriptive, not a claim that one material is safer or more effective. Head-to-head observational comparisons may be affected by patient selection, injected volume, operator technique, learning curve and treatment planning. They cannot by themselves establish universal superiority.

What about previous surgery or salvage radiotherapy?

Previous prostate procedures, pelvic surgery, focal therapy, radiotherapy or inflammation may alter the tissue plane behind the prostate. This can make placement more difficult or unsuitable.

The evidence for spacers in salvage or re-irradiation settings is less established than for primary prostate radiotherapy. These cases require individual assessment in an experienced multidisciplinary setting.

Questions to ask before deciding

  • What bowel risks are associated with my proposed radiotherapy plan?
  • Can the required rectal dose limits be met without a spacer?
  • What additional benefit is expected in my anatomy?
  • What spacer material is proposed, and is the exact device included in the ARTG for this intended use?
  • What evidence supports it for my radiation schedule?
  • Who will perform the procedure, and what is their experience?
  • What are the recognised contraindications and complications?
  • How will my anticoagulant or antiplatelet medicines be managed?
  • What symptoms after insertion require urgent review?
  • What are the alternatives if I choose not to have a spacer?
  • Are there additional costs or gaps?

Australian regulatory considerations

The Australian Register of Therapeutic Goods (ARTG) is the public database of therapeutic goods that may be legally supplied in Australia, unless an exemption or another authorised access pathway applies. An ARTG entry records the particular sponsor and intended purpose; it is not a general recommendation that the product is best for an individual patient.

Device inclusion, instructions for use, contraindications, availability and reimbursement can change. The treating team should confirm the current ARTG entry and approved instructions for the exact device proposed.

The bottom line

The rectum lies close to the prostate and may receive some radiation during prostate-cancer treatment. Modern planning and image guidance are the foundation of rectal protection.

A biodegradable rectal spacer can create temporary separation and may reduce rectal radiation exposure in selected patients. It does not treat the cancer, cannot guarantee freedom from bowel effects and introduces procedural risks of its own.

The decision should be individualised according to anatomy, the proposed radiation plan, expected dosimetric benefit, medical history, bleeding risk and local expertise. It should be made before radiotherapy planning through an informed discussion with the treating radiation oncology team.

This article provides general disease education and does not replace individual medical advice. It does not promote or recommend a particular therapeutic device, spacer material, brand, clinician or health service.

References and further reading