Rectal Spacers and Fiducial Markers for Prostate Radiation Therapy

If you're preparing for radiation therapy for prostate cancer, your care team may recommend a rectal spacer, fiducial markers, or both. This video explains how these tools help improve the accuracy and safety of radiation treatment, what to expect during the procedure, and how to prepare for recovery afterward.

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Developed in collaboration with Memorial Sloan Kettering Cancer Center.

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Read the full video transcript below:

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If you’re getting ready for radiation therapy for prostate cancer, your care team may recommend a procedure to place a rectal spacer, fiducial markers, or both. This video explains what these are, why they’re used, and what to expect before, during, and after the procedure.

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Not every patient needs the same approach. Some patients will receive a rectal spacer only, some receive fiducial markers only, while others will receive both a rectal spacer and fiducial markers. Your doctor will tell you which option is right for your treatment plan.

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First, a quick review of the prostate.  The prostate is a small, walnut-sized gland located just below the bladder and directly in front of the rectum. It surrounds the urethra, which carries urine out of the body, and it helps produce fluid that’s part of semen.

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A rectal spacer, is a soft gel placed between the prostate and the rectum. By gently creating space between these two areas, the spacer helps protect the rectum from radiation and lowers the risk of side effects. The spacer stays in place for about six months and is then naturally absorbed by your body.

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Some patients will also have fiducial markers placed. These are very small metal markers—about the size of a grain of rice—that are placed inside the prostate. Because the prostate can move slightly during your treatment, the markers help your radiation team line up the radiation beams accurately and adjust during treatment.  This allows treatment to be delivered more precisely. The markers stay in the prostate permanently and do not cause harm.

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Before your procedure, your care team will review your medical history and medications. It’s important to tell them if you take blood thinners, supplements, or certain other medications, or if you’ve had infections after prostate procedures in the past. If you take medications for weight loss, let your care team know—these medicines may need to be stopped earlier and may require longer fasting before your procedure. Follow your provider’s instructions about medication changes, eating, drinking, and using saline enemas before your appointment.  This helps avoid cancellation and rescheduling the procedure.

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On the day of the procedure, an IV will be placed so you can receive anesthesia.  You will be asleep during the procedure.

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Once you’re asleep, your provider will use ultrasound imaging to guide the procedure. If fiducial markers are part of your treatment, small needles are used to place them into the prostate. Next, the rectal spacer gel is injected into the space between the prostate and rectum. If you’re only receiving a rectal spacer, the marker placement step is skipped.

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After the procedure, you’ll wake up in the recovery area and go home the same day with a responsible adult.

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At home, it’s normal to feel mild soreness or a sense of fullness in the rectal area for a day or two. Over-the-counter pain medicine is usually enough to manage discomfort, and you’ll take antibiotics for a few days to help prevent infection.

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Most people can return to their normal diet right away and resume usual activities within 24 hours. You should avoid placing anything in the rectum for several months unless your care team gives you specific instructions for radiation treatment.

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Call your healthcare provider if you develop a fever, chills, increasing pain, trouble urinating, or notice blood in your urine or stool.

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Rectal spacers and fiducial markers are important tools that help make prostate radiation therapy safer and more precise. If you have questions, talk with your care team—they’re there to support you.

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This video is for educational purposes only and is not medical advice. Always follow the guidance of your healthcare provider.