What factors do you take into account when deciding to offer SpaceOAR to patients with prostate cancer planning to undergo radiation therapy?

A shared decision-making opportunity.

It has been interesting to see the pendulum of physician opinion swing back and forth a bit on this issue. [For those unfamiliar with the topic, in addition to reading the initial RCT results, it is worthwhile to read the later Lancet commentary: Hall et al., P...

Very important question, as it is my belief that this is a great example of overuse of a medical device. There is evidence to suggest that in some individuals the use of a rectal spacing gel is beneficial and the risks vs the benefit balances more towards the benefits, such as those undergoing SBRT,...

Everyone has varying levels of enthusiasm about a hydrogel (not differentiating between SpaceOAR vs Barrigel).

My personal practice is as follows:
Conventional Fx/Mod Hypo Fx - I do not recommend it as the margins used in the trial 'proving' SpaceOARs use were much larger than what I currently use wi...

I would offer to patients that would benefit the most: recurrence after previous radiation (yes, it is possible), history of inflammatory bowel disease, and those requiring high dose (high risk patients). I would not offer in patients T3 or T4, history fistula, or previous surgery in the anal/rectum...

If a patient asks about it or has read on it and wants it, I won't object. Otherwise, it's my call. And there haven't been many times I've needed to pick up.

Would a patient who needs to be on chronic anti-coagulation change your recommendation?