Jonathan D. Tward, MD, PhD, FASTRO, presented “A Review of Prostate Cancer Perirectal Spacers” during the 35th International Prostate Cancer Update conference on February 9, 2025, in Vail, Colorado.
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How to cite: Tward, Jonathan D. “A Review of Prostate Cancer Perirectal Spacers.” February 9, 2025. Accessed Apr 2026. https://grandroundsinurology.com/a-review-of-prostate-cancer-perirectal-spacers/
A Review of Prostate Cancer Perirectal Spacers – Summary
Jonathan D. Tward, MD, PhD, FASTRO, Professor of Radiation Oncology, University of Utah, Salt Lake City, Utah, explores rectal spacing techniques designed to minimize radiation exposure to the rectum during prostate cancer treatment. In this 18-minute presentation, Dr. Tward highlights three available products: SpaceOAR, Barrigel, and the BioProtect balloon, each with distinct characteristics.
Dr. Tward compares the benefits of each approach, discussing repositioning ability and volume control. Each option is reversible, with SpaceOAR absorbing in five to six months, while Barrigel can be actively dissolved using hyaluronidase if necessary. The BioProtect balloon allows deflation through aspiration.
Dr. Tward discusses potential complications, noting that rare but severe injuries, such as fistulas and infections, can occur if the spacer is incorrectly placed. Injection into the rectal wall rather than the correct perirectal space may lead to devastating outcomes. Tward emphasizes that spacer complications are often under-reported, with an estimated 1 in 150 patients experiencing significant side effects, even in experienced hands. In an effort to improve outcomes, he shares a short training video of an insertion procedure.
Dr. Tward relays that each product has merits. He encourages clinicians to weigh the evidence and product characteristics when selecting a rectal spacing strategy for their patients.
About the 35th International Prostate Cancer Update:
The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 35 will feature lectures, interactive discussions, panel roundtables, debates, and case reports. This conference is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.
The goal of this educational program is to equip healthcare professionals involved in the diagnosis and treatment of prostate cancer with the up-to-date clinical knowledge and tools they need to best treat their patients. The program will discuss the treatment of prostate cancer from diagnosis to treating advanced and metastatic disease. The conference aims to give physicians exposure to a comprehensive review of treating prostate cancer patients and to give them a chance to discuss the issues with peers and experts. You can learn more about the conference here.
ABOUT THE AUTHOR
Jonathan D. Tward, MD, PhD, FASTRO is a tenured Professor in the Department of Radiation Oncology at the University of Utah, where he also serves as the physician lead on several operational committees and working groups.. Dr. Tward holds the The Vincent P. and Janet Mancini Presidential Endowed Chair at Huntsman Cancer Institute (HCI) in Genitourinary Malignancies and is the leader of the HCI Genitourinary Cancers Center (GUCC). In that role, Dr. Tward is responsible for the strategic vision and operations of the GUCC, including the multidisciplinary collaboration of patient care, community engagement, research, and donor relations. Before joining HCI, Dr. Tward founded and served as the CEO or on the Board of Directors for several pioneering ecommerce and health-related websites. Dr. Tward earned a bachelor's degree in biology at the University of California, Los Angeles, a PhD in biochemistry, and an MD at Tufts University in Boston, Massachusetts. He completed a residency in radiation oncology at the University of Utah.
Dr. Tward is an expert at delivering highly precise and targeted radiation therapy to people afflicted with cancers of the prostate, bladder, kidney, testis, and penis. He uses the vast array of technologies available at the HCI to deliver intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), stereotactic body radiotherapy (SBRT), as well as low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy.
As a practicing physician and scientist, mentor, and educator, Dr. Tward has contributed to over 80 published-peer reviewed journal articles. He is the Principal Investigator (PI) on several ongoing investigator-initiated clinical trials and is the site PI on numerous cooperative group or industry-sponsored clinical trials. Dr. Tward serves as the Utah State Captain for the American Society of Radiation Oncology (ASTRO) and on the National Comprehensive Cancer Networks (NCCN) clinical practice guidelines committees for prostate, bladder, and penile cancers. As a member of the NCCN Framework for Resource Stratification subcommittees, Dr. Tward helps define appropriate cancer treatment pathways of low- and middle-resource countries where specific diagnostic tests or treatment approaches may be unavailable.
