Concierge 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.
Why patients choose us
- 01
A consultant clinical oncologist or urologist, in theatre
Not a general list and not a trainee. A named clinician who places spacers regularly, in a proper day-case theatre with ultrasound guidance.
- 02
Placed before the plan is drawn
The spacer goes in first, then the planning CT/MRI is done — so your radiotherapy is calculated on the anatomy you will actually be treated with.
- 03
Independent, and free
We are paid by no clinic, so the recommendation — spacer or no spacer, SpaceOAR or Barrigel — is impartial and costs you nothing.
Indicative pricing
What a private hydrogel spacer costs in the UK.
Indicative ranges across our partner centres. Send the details and we quote firm figures across two or three options.
In short
SpaceOAR under LA and sedation, in our network: £2,500–£3,800, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| SpaceOAR hydrogel — device + insertion (LA + sedation) | £2,500–£3,800 | 30–45 min | Same day |
| Barrigel hyaluronic acid spacer — device + insertion | £2,800–£4,200 | 30–45 min | Same day |
| Spacer under spinal or GA (uplift) | +£600–£1,200 | Half-day | Same day |
| Post-implant planning CT | £350–£600 | 20 min | 1–2 days |
| Post-implant planning MRI (prostate protocol) | £450–£800 | 30 min | 1–2 days |
| Oncology consultation only | £250–£450 | 30–45 min | Same visit |
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. We come back with a firm quote within one working day.
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.
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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.
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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.
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Want it done properly?
A named consultant, a proper theatre, either SpaceOAR or Barrigel, and a planning scan done on the spaced anatomy.
The journey
From enquiry to first radiotherapy session — what happens, in order.
One clinician from first message through spacer placement, planning scan and the start of treatment.
Phase 1 · Before placement
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us about your diagnosis
A short, confidential form. Prostate cancer stage, PSA, Gleason, the radiotherapy schedule your oncologist has proposed.
- 02
Before
We come back with a recommendation
Within one working day: whether a spacer is likely to help you, which product (SpaceOAR or Barrigel), which centre, and an indicative price.
- 03
Before
We arrange the appointment
Usually within one to two weeks. Any blood-thinning medication is reviewed with the team and you are told exactly how to prepare — bowel prep, antibiotics, fasting.
- 04
On the day
Arrival at the clinic
Arrival, consent and a chat with the clinician and anaesthetist. Local plus IV sedation, spinal or GA — whichever was chosen.
- 05
On the day
The placement itself
30 to 45 minutes in a proper theatre. Lithotomy, transperineal ultrasound-guided needle, saline hydrodissection first, then the hydrogel — 10 ml SpaceOAR or 12–15 ml Barrigel.
- 06
On the day
Home the same day
A short recovery, written aftercare, and home within a few hours. With sedation, spinal or GA you will need someone to collect you.
- 07
After
Planning scan and radiotherapy
A post-implant CT and/or MRI is done for the radiotherapy plan. Treatment usually starts one to three weeks later. The hydrogel is absorbed at 6–12 months.
Typical end-to-end: 2–3 weeks from enquiry to placement. Radiotherapy starts 1–3 weeks after that. Spacer absorbed at 6–12 months.
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.
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Planned external beam radiotherapy (EBRT)
Any man with localised prostate cancer scheduled for VMAT or IMRT — the commonest indication and the strongest evidence base.
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Stereotactic body radiotherapy (SBRT)
Five-fraction SBRT delivers a very high dose per session — a spacer reduces the rectal dose that matters most.
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Proton beam therapy
Protons still deposit dose in the rectum where it abuts the prostate — a spacer widens that gap by roughly 1 cm.
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Localised prostate cancer, T1–T3a
Best-selected patients: cancer confined to the prostate or with limited extracapsular extension, no rectal invasion.
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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.
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Prior pelvic conditions, carefully selected
Haemorrhoids, mild prior inflammation or a small prostate can still be candidates — the decision is made case by case.
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Not for salvage after radiotherapy
Post-radiation fibrosis makes the plane unreliable. Spacers are best placed before the first course of radiotherapy, not after.
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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.
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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.
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Barrigel hyaluronic acid (Palette Life Sciences)
A non-animal stabilised hyaluronic acid — more mouldable, allowing shape tuning during placement. Absorbed at ~12 months.
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LA plus IV sedation
The most common choice. Comfortable, awake enough to reposition, home within hours. Suits most men.
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Spinal anaesthetic
Numb from the waist down without full sedation. Useful if IV sedation is not preferred.
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General anaesthetic
Asleep in a proper theatre with an anaesthetist. Reserved for anxious patients or when combined with another procedure.
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Combined with fiducial markers
Gold seed fiducials for image-guided radiotherapy are often placed at the same visit, through the same setup.
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Post-implant planning scan
A CT and/or MRI after placement lets the oncology team draw the radiotherapy plan on the actual spaced anatomy.
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Consultation only
An honest discussion of whether a spacer is likely to help you, given your stage, anatomy, and radiotherapy plan — no obligation.
Our vetted UK network
A small panel of clinicians, we picked them.
Consultant clinical oncologists and urologists across London, the South-East and major UK cities. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinician in our network.
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Consultant clinical oncologists or urologists who place spacers regularly
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Ultrasound-guided transperineal technique with saline hydrodissection
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Access to both SpaceOAR and Barrigel — the product chosen for the patient, not the clinic
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On-site or partnered radiotherapy planning (CT and MRI) within one to three weeks
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.
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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%.
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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.
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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.
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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.
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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.
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Infection under 0.1%
Antibiotic cover, a sterile field and a transperineal (not transrectal) approach keep infection rates very low.
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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.
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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.
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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 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.
- 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.
- 02 Technique
Approach and hydrodissection
Transperineal ultrasound-guided approach, saline hydrodissection of the plane between Denonvilliers’ fascia and rectum, then hydrogel injection.
- 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.
- 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
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. We confirm cover before booking.
Frequently asked
Everything we get asked about hydrogel spacers.
Quick answers on evidence, cost, product choice, and what the placement is actually like.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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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