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Oncology · United Kingdom

A hydrogel spacer between prostate and rectum, before radiotherapy begins.

A small injection of SpaceOAR or Barrigel - roughly a centimetre of extra space between the prostate and the rectum - placed by a consultant, so your radiotherapy plan is calculated on the anatomy you will actually be treated with.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private hydrogel spacer costs in the UK.

Indicative ranges across our partner centres.

In short

£2,500–£3,800, home the same day.

Procedure Indicative range
SpaceOAR hydrogel - device + insertion (LA + sedation) £2,500–£3,800
Barrigel hyaluronic acid spacer - device + insertion £2,800–£4,200
Spacer under spinal or GA (uplift) +£600–£1,200
Post-implant planning CT £350–£600
Post-implant planning MRI (prostate protocol) £450–£800
Oncology consultation only £250–£450

Prices vary by centre, by the clinician placing the spacer, by the anaesthetic chosen, and by whether fiducial markers or the planning scan are bundled on the same day. NHS-commissioned placement is available at some centres - we will tell you honestly if that is a route worth exploring first.

The problem

The rectum sits within millimetres of the prostate.

Modern prostate radiotherapy is precise - but the anterior rectal wall is only a few millimetres from the target. A hydrogel spacer widens that gap by roughly a centimetre, and the difference in long-term bowel side effects is measurable.

  • Not sure whether you need one?

    Not every man does. We give you an honest read on the likely benefit for your stage, anatomy and radiotherapy plan.

  • Worried about the risks?

    Rectal injection is rare with proper ultrasound-guided technique. The team’s experience matters - that is the point of a small vetted panel.

  • Want it done properly?

    A named consultant, a proper theatre, either SpaceOAR or Barrigel, and a planning scan done on the spaced anatomy.

When it helps

When a hydrogel spacer is the right step.

The situations we see most, plus the two red flags that mean a spacer is not the right choice.

  • Planned external beam radiotherapy (EBRT)

    Any man with localised prostate cancer scheduled for VMAT or IMRT - the commonest indication and the strongest evidence base.

  • Stereotactic body radiotherapy (SBRT)

    Five-fraction SBRT delivers a very high dose per session - a spacer reduces the rectal dose that matters most.

  • Proton beam therapy

    Protons still deposit dose in the rectum where it abuts the prostate - a spacer widens that gap by roughly 1 cm.

  • Localised prostate cancer, T1–T3a

    Best-selected patients: cancer confined to the prostate or with limited extracapsular extension, no rectal invasion.

  • Younger men and long life expectancy

    Late rectal toxicity accumulates over years - the men with most to lose from bowel side effects have most to gain from a spacer.

  • Prior pelvic conditions, carefully selected

    Haemorrhoids, mild prior inflammation or a small prostate can still be candidates - the decision is made case by case.

  • Not for salvage after radiotherapy

    Post-radiation fibrosis makes the plane unreliable. Spacers are best placed before the first course of radiotherapy, not after.

  • Red flag: rectal invasion or fistula

    A tumour extending into the rectal wall, or an existing fistula, is a contraindication - the spacer cannot safely be placed.

Options

SpaceOAR or Barrigel - and which anaesthetic.

What each option on the table actually involves - the two products, the three anaesthetic choices, and what usually pairs with the spacer visit.

  • SpaceOAR hydrogel (Boston Scientific)

    A polyethylene glycol hydrogel - the most-studied option, backed by NICE IPG590 and the Mariados randomised trial. Absorbed at ~6 months.

  • Barrigel hyaluronic acid (Palette Life Sciences)

    A non-animal stabilised hyaluronic acid - more mouldable, allowing shape tuning during placement. Absorbed at ~12 months.

  • LA plus IV sedation

    The most common choice. Comfortable, awake enough to reposition, home within hours. Suits most men.

  • Spinal anaesthetic

    Numb from the waist down without full sedation. Useful if IV sedation is not preferred.

  • General anaesthetic

    Asleep in a proper theatre with an anaesthetist. Reserved for anxious patients or when combined with another procedure.

  • Combined with fiducial markers

    Gold seed fiducials for image-guided radiotherapy are often placed at the same visit, through the same setup.

  • Post-implant planning scan

    A CT and/or MRI after placement lets the oncology team draw the radiotherapy plan on the actual spaced anatomy.

Safety and outcomes

What the evidence says - and what to watch for.

Rectal V70 typically falls from 6–8% to 1–2%. Late rectal toxicity of grade 2 or worse is roughly halved. Quality of life for the bowel is sustainably better, urinary quality of life is marginally better, and cancer control is unchanged.

  • Rectal wall injection is rare - and preventable

    Careful saline hydrodissection first, then hydrogel, keeps the plane clean. The published rate of accidental rectal injection with modern technique is under 0.5%.

  • Perineal discomfort for a few days

    A dull ache or bruised sensation in the perineum for two to five days is normal. Simple painkillers are enough for almost everyone.

  • Transient urinary symptoms

    Some men have short-lived dysuria or difficulty passing urine in the first 24–48 hours. Retention needing a catheter is uncommon.

  • Rare pulmonary or venous embolism

    Case reports exist of small amounts of hydrogel entering venous or pulmonary circulation. Meticulous ultrasound-guided technique keeps this vanishingly rare.

  • Migration is uncommon with modern technique

    The spacer occasionally settles into a slightly different shape than planned. Meaningful migration that affects the radiotherapy plan is rare.

  • Infection under 0.1%

    Antibiotic cover, a sterile field and a transperineal (not transrectal) approach keep infection rates very low.

  • Sometimes it cannot be placed fully

    Fibrotic tissue from prior surgery or previous radiation can prevent full separation. The clinician will tell you honestly if the plane is not opening.

  • Allergic reaction is rare

    Reported very occasionally for both hydrogel and hyaluronic acid. If you have a known allergy to either, tell the team before booking.

  • It disappears on its own

    The spacer is fully absorbed at 6–12 months and leaves no permanent implant behind.

Reading your procedure note

Your procedure note in four parts. Read the last one first.

Whichever product was used, the note the clinician sends you keeps to the same shape.

A UK clinical oncologist reviewing a patient’s procedure notes

A quiet reminder

Oncology language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your first radiotherapy session, just ask.

  1. 01 Header

    Product used and volume placed

    Which spacer (SpaceOAR or Barrigel), the volume injected (typically 10 ml or 12–15 ml), and the anaesthetic used.

  2. 02 Technique

    Approach and hydrodissection

    Transperineal ultrasound-guided approach, saline hydrodissection of the plane between Denonvilliers’ fascia and rectum, then hydrogel injection.

  3. 03 Findings

    Separation achieved and distribution

    The prostate–rectum separation on post-implant imaging (target ~1 cm), and any notes on the shape and symmetry of the spacer.

  4. 04 Impression

    Radiotherapy timing and follow-up

    Read this first: when planning imaging and radiotherapy are scheduled, and any specific instructions before your first treatment session.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for hydrogel spacers varies by insurer - usually funded as part of a prostate radiotherapy pathway when medically indicated. NHS-commissioned placement is available at some centres.

Frequently asked

Everything we get asked about hydrogel spacers.

Quick answers on evidence, cost, product choice, and what the placement is actually like.

  • What is a hydrogel perirectal spacer and why would I need one?

    It is a small volume of gel - either polyethylene glycol (SpaceOAR) or hyaluronic acid (Barrigel) - injected between the prostate and the rectum before prostate radiotherapy. It pushes the rectum roughly 1 cm away from the prostate, so the rectum receives far less radiation. That reduces the risk of long-term bowel side effects.

  • How much does the rectal dose actually drop?

    In published series the rectal V70 (the volume of rectum receiving 70 Gy or more) typically falls from around 6–8% to 1–2%. In practical terms, late rectal toxicity of grade 2 or worse is roughly halved - the finding first shown by the Mariados NCI trial and confirmed in long-term follow-up.

  • SpaceOAR or Barrigel - which is better?

    Both work. SpaceOAR is polyethylene glycol, has the longer track record and is the product NICE IPG590 was written around. Barrigel is hyaluronic acid, is more mouldable during placement and absorbs a little later. We help you and your oncologist pick between them.

  • Does a spacer affect whether the cancer is cured?

    No. Randomised and long-term data show no negative impact on cancer control - the radiotherapy dose to the prostate itself is unchanged. The spacer only changes the dose the rectum receives.

  • How much does a private hydrogel spacer cost in the UK?

    Roughly £2,500–£3,800 for SpaceOAR and £2,800–£4,200 for Barrigel, device plus insertion, under local anaesthetic with sedation. Spinal or GA adds £600–£1,200. NHS-commissioned placement is available at some centres.

  • Will it hurt, and how long does the placement take?

    The placement itself takes 30–45 minutes and you feel nothing at the time. Afterwards there is a dull perineal ache for two to five days, controlled with simple painkillers.

  • When does the spacer disappear?

    It is fully absorbed by your body at 6–12 months - SpaceOAR closer to 6 months, Barrigel closer to 12. Nothing permanent is left behind.

  • Is a spacer suitable for every man having prostate radiotherapy?

    It is suitable for most well-selected men with localised prostate cancer (T1–T3a) planned for external beam radiotherapy, SBRT or proton therapy. It is not suitable if the tumour has invaded the rectal wall, if there is a fistula, or after a previous course of pelvic radiotherapy.

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