Prostate cancer treatment: how to reduce the side effects of radiotherapy

Written by: Mr Neil Haldar
Edited by: Laura Burgess

If you are going to have radiotherapy as part of your prostate cancer treatment, you may be researching the possible side effects of the procedure. Most patients will experience an increase in the need to urinate, a weak urinary stream, difficulty even starting urination and diarrhoea in the weeks after radiotherapy.

Thankfully, there is a follow-up procedure known as SpaceOAR® Hydrogel, which can be used to minimise the harmful and unpleasant side effects of prostate radiotherapy. Consultant urologist Mr Neil Haldar explains how it works, the benefits and its effectiveness.

What is the SpaceOAR® Hydrogel?

The SpaceOAR® Hydrogel was designed to reduce radiation exposure to the organs surrounding the prostate during prostate radiotherapy. The reduction in radiation exposure to surrounding organs can reduce the side effects such as rectal bleeding, loose bowel motions, urinary incontinence and impotence. (See references at the end of this article).

What happens during the procedure?

SpaceOAR® Hydrogel is a soft gel implanted between the prostate and rectum to create a space. This space is important as it pushes the rectum away from the prostate and therefore, the radiotherapy field.

This allows a maximum dose of radiotherapy to be delivered to the prostate gland and therefore to the prostate cancer whilst avoiding unnecessary irradiation of surrounding tissue. This, therefore, minimises harmful and potentially unpleasant side effects.

The gel is implanted through a minimally invasive procedure under ultrasound guidance. The SpaceOAR procedure is usually performed under local anaesthetic. The gel remains in place for up to six months, whilst it is naturally absorbed by the patient’s body.

Watch a video on the procedure

How safe is SpaceOAR® hydrogel?

SpaceOAR® hydrogel has been implanted in over 50,000 men worldwide and evaluated in over 60 publications. The studies have consistently found that SpaceOAR is safe and effective.

What are the benefits?

The studies in patients undergoing prostate cancer radiotherapy report benefits, including:

  • A reduction in rectal toxicity from radiation from 9.2% in the control group vs 2% in the group receiving the SpaceOAR gel.
  • A reduction in urinary incontinence from 19.6% in the control group to 4.3% in the SpaceOAR hydrogel group.
  • A reduction in the decline of bowel Quality of Life from 20.5% in the control group vs 5.4% in the hydrogel spacer group.
  • Potent men were twice as likely to retain erections sufficient for intercourse in the group who received the hydrogel rectal spacer before prostate radiotherapy. Approximately 37.5% control vs 66.7% treated. (See references).

Mr Haldar is an expert in treating prostate cancer, benign prostate enlargement, prostate removal and kidney stones. Do not hesitate to book an appointment for a consultation now via his Top Doctor’s profile.


1) Hamstra D, Mariados N, Sylvester J et al. Continued Benefit to Rectal Separation for Int J Radiat Oncol Biol Phys. 2017 Apr 1;97(5):976-985. DOI: 10.1016/j.ijrobp.2016.12.024. Epub 2016 Dec 23.

2) Hamstra D, et al. Evaluation of sexual function on a randomised trial of a prostate rectal

3) Hamstra DA, Mariados N, Sylvester J et al. Sexual quality of life following prostate intensity-modulated radiation therapy (IMRT) with a rectal/prostate spacer: Secondary analysis of a phase 3 trial. Pract Radiat Oncol. 2018 Jan - Feb;8(1):e7-e15. DOI: 10.1016/j.prro.2017.07.008. Epub 2017 Jul 19.

4) SpaceOAR, What is SpaceOAR® Hydrogel?: [accessed February 2018]

By Mr Neil Haldar

Mr Neil Haldar is a leading consultant urological surgeon based in Buckinghamshire. He sees both adult and paediatric patients. After graduating from King's College Medical School in 1992 Mr Haldar went on to join the Oxford Junior Surgical training program. From there Mr Haldar was awarded by the Royal College of Surgeons the Allinson Foundation Research Fellowship in which he was able to undertake his Master's degree at the Nuffield Department of Surgery in Oxford. Once he completed his specialty urological training, Mr Haldar became the Clinical Lead in laparoscopic urology at the Buckinghamshire NHS Trust. 

Mr Haldar is well published in most aspects of urology, with a current focus on researching Enhanced Recovery Surgery. Mr Haldar's main clinical specialties include bladder, prostate and kidney cancer. He is also an expert in minimal access surgery and in 2008 was one of the first UK surgeons to perform a single incision transperitoneal and extraperitoneal laproscopic nephrectomy. Mr Haldar also treats urinary tract infections, phimosis, circumcision, foreskin problems, hydrocoele, undecended Testes (cryptorchidism), varicocoele and herniotomy.

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