Rectal perforation following SpaceOAR placement combined with permanent prostate brachytherapy

We report a case of rectal perforation following SpaceOAR placement utilized with iodine-125 low-dose-rate brachytherapy for prostate cancer.

A 65-year-old patient with localized prostate cancer underwent SpaceOAR placement following LDR-BT. No significant issues occurred with the SpaceOAR procedure, and no abnormalities were found on the next day's T2-weighted magnetic resonance imaging. Two weeks later, a colonoscopy was performed due to mucus stools revealing rectal perforation attributed to SpaceOAR. By maintaining Macrogol 4000 and a low residue diet, the perforation healed within 6 months.

Rectal ulcers and perforations are the most common severe adverse events from SpaceOAR placement. Effective management strategies are crucial since complications can't be entirely avoided, even with skilled surgeons.