{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T10:45:32Z","timestamp":1774608332659,"version":"3.50.1"},"reference-count":25,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","goldjournal.net","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Urology"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.urology.2025.06.070","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T02:13:24Z","timestamp":1751422404000},"page":"129-135","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"special_numbering":"C","title":["Utilization, Acute Complications, and Delays in Treatment Associated With Rectal Spacers for Prostate Cancer Radiotherapy"],"prefix":"10.1016","volume":"205","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0436-2746","authenticated-orcid":false,"given":"Jack C.","family":"Millot","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adithya","family":"Balasubramanian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Chew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gal","family":"Wald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilo","family":"Arenas-Gallo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"McCann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo D.","family":"Dreyfuss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Rhodes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Lewicki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela Y.","family":"Jia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas G.","family":"Zaorsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan E.","family":"Shoag","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.urology.2025.06.070_bib1","unstructured":"American Cancer Society. Key Statistics for Prostate Cancer. Accessed February 13, 2025. https:\/\/www.cancer.org\/cancer\/types\/prostate-cancer\/about\/key-statistics.html."},{"key":"10.1016\/j.urology.2025.06.070_bib2","first-page":"2351","article-title":"Trends in treatments for prostate cancer in the United States, 2010-2015","volume":"11","author":"Wang","year":"2021","journal-title":"Am J Cancer Res"},{"key":"10.1016\/j.urology.2025.06.070_bib3","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.prro.2023.09.007","article-title":"Radiation therapy summary of the AUA\/ASTRO guideline on clinically localized prostate cancer","volume":"14","author":"Deville","year":"2024","journal-title":"Pract Radiat Oncol"},{"key":"10.1016\/j.urology.2025.06.070_bib4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.radonc.2020.04.037","article-title":"Ultrahypofractionated versus hypofractionated and conventionally fractionated radiation therapy for localized prostate cancer: a systematic review and meta-analysis of phase III randomized trials","volume":"148","author":"Lehrer","year":"2020","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.urology.2025.06.070_bib5","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.ijrobp.2015.04.030","article-title":"Hydrogel spacer prospective multicenter randomized controlled pivotal trial: dosimetric and clinical effects of perirectal spacer application in men undergoing prostate image guided intensity modulated radiation therapy","volume":"92","author":"Mariados","year":"2015","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.urology.2025.06.070_bib6","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.ijrobp.2016.12.024","article-title":"Continued benefit to rectal separation for prostate radiation therapy: final results of a phase III trial","volume":"97","author":"Hamstra","year":"2017","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.urology.2025.06.070_bib7","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1001\/jamaoncol.2022.7592","article-title":"Hyaluronic acid spacer for hypofractionated prostate radiation therapy: a randomized clinical trial","volume":"9","author":"Mariados","year":"2023","journal-title":"JAMA Oncol"},{"key":"10.1016\/j.urology.2025.06.070_bib8","doi-asserted-by":"crossref","DOI":"10.1001\/jamaoncol.2023.4267","article-title":"Increasing use of shorter-course radiotherapy for prostate cancer","author":"Yu","year":"2023","journal-title":"JAMA Oncol"},{"key":"10.1016\/j.urology.2025.06.070_bib9","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.urology.2023.12.034","article-title":"Major complications and adverse events related to use of SpaceOAR hydrogel for prostate cancer radiotherapy","volume":"188","author":"Millot","year":"2024","journal-title":"Urology"},{"key":"10.1016\/j.urology.2025.06.070_bib10","unstructured":"Merative. MarketScan Research Databases for life sciences researchers. Accessed July 28, 2024. https:\/\/www.merative.com\/documents\/brief\/marketscan-research-databases-for-life-sciences-researchers."},{"key":"10.1016\/j.urology.2025.06.070_bib11","unstructured":"U.S. Census Bureau. American Community Survey 1-year estimates. Published 2021. Accessed April 18, 2024. https:\/\/data.census.gov\/cedsci\/."},{"key":"10.1016\/j.urology.2025.06.070_bib12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.ijrobp.2021.03.025","article-title":"A multi-institutional phase 2 trial of high-dose SAbR for prostate cancer using rectal spacer","volume":"111","author":"Folkert","year":"2021","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.urology.2025.06.070_bib13","article-title":"SpaceOAR hydrogel spacer injection prior to stereotactic body radiation therapy for men with localized prostate cancer: a systematic review","volume":"100","author":"Payne","year":"2021","journal-title":"Medicine (United States)"},{"key":"10.1016\/j.urology.2025.06.070_bib14","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.euo.2019.09.006","article-title":"Early tolerance and tumor control outcomes with high-dose ultrahypofractionated radiation therapy for prostate cancer","volume":"3","author":"Zelefsky","year":"2020","journal-title":"Eur Urol Oncol"},{"key":"10.1016\/j.urology.2025.06.070_bib15","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s13014-021-01834-1","article-title":"Phase II study of stereotactic body radiotherapy with hydrogel spacer for prostate cancer: acute toxicity and propensity score-matched comparison","volume":"16","author":"Ogita","year":"2021","journal-title":"Radiat Oncol"},{"key":"10.1016\/j.urology.2025.06.070_bib16","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.1016\/j.urology.2021.05.013","article-title":"SpaceOAR hydrogel spacer for reducing radiation toxicity during radiotherapy for prostate cancer. A systematic review","volume":"156","author":"Armstrong","year":"2021","journal-title":"Urology"},{"key":"10.1016\/j.urology.2025.06.070_bib17","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.meddos.2022.02.003","article-title":"The dosimetric advantages of perirectal hydrogel spacer in men with localized prostate cancer undergoing stereotactic ablative radiotherapy (SABR)","volume":"47","author":"Sturt","year":"2022","journal-title":"Med Dosimetry"},{"issue":"1","key":"10.1016\/j.urology.2025.06.070_bib18","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00345-024-04784-x","article-title":"One-year clinical outcomes of MR-guided stereotactic body radiation therapy with rectal spacer for patients with localized prostate cancer","volume":"42","author":"Poon","year":"2024","journal-title":"World J Urol"},{"issue":"3","key":"10.1016\/j.urology.2025.06.070_bib19","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2025.0491","article-title":"Bowel disorder incidence and rectal spacer use in patients with prostate cancer undergoing radiotherapy","volume":"8","author":"Folkert","year":"2025","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.urology.2025.06.070_bib20","doi-asserted-by":"crossref","first-page":"e31s","DOI":"10.1200\/JOP.2012.000548","article-title":"Cost-effectiveness analysis of stereotactic body radiation therapy versus intensity-modulated radiation therapy: an emerging initial radiation treatment option for organ-confined prostate cancer","volume":"8","author":"Hodges","year":"2012","journal-title":"J Oncol Pract"},{"key":"10.1016\/j.urology.2025.06.070_bib21","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.urology.2017.11.016","article-title":"Absorbable hydrogel spacer use in prostate radiotherapy: a comprehensive review of phase 3 clinical trial published data","volume":"115","author":"Karsh","year":"2018","journal-title":"Urology"},{"key":"10.1016\/j.urology.2025.06.070_bib22","first-page":"101516","article-title":"Rectourethral fistula following SpaceOAR gel placement for prostate cancer radiotherapy: a rare complication","volume":"35","author":"Kuperus","year":"2021","journal-title":"Urol Case Rep"},{"key":"10.1016\/j.urology.2025.06.070_bib23","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1097\/JU.0000000000001601","article-title":"Systematic review of time to definitive treatment for intermediate risk and high risk prostate cancer: Are delays associated with worse outcomes?","volume":"205","author":"Nguyen","year":"2021","journal-title":"J Urol"},{"key":"10.1016\/j.urology.2025.06.070_bib24","unstructured":"Palette Life Sciences. Barrigel: proven safe and effective at reducing radiation therapy side effects. Accessed March 1, 2025. https:\/\/barrigel.com\/hcp\/barrigel-proven-safe-and-effective."},{"key":"10.1016\/j.urology.2025.06.070_bib25","doi-asserted-by":"crossref","first-page":"4657","DOI":"10.3390\/cancers15184657","article-title":"MRI-guided radiation therapy for prostate cancer: the next frontier in ultrahypofractionation","volume":"15","author":"Benitez","year":"2023","journal-title":"Cancers (Basel)"}],"container-title":["Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0090429525006478?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0090429525006478?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T12:28:23Z","timestamp":1763468903000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0090429525006478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":25,"alternative-id":["S0090429525006478"],"URL":"https:\/\/doi.org\/10.1016\/j.urology.2025.06.070","relation":{},"ISSN":["0090-4295"],"issn-type":[{"value":"0090-4295","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Utilization, Acute Complications, and Delays in Treatment Associated With Rectal Spacers for Prostate Cancer Radiotherapy","name":"articletitle","label":"Article Title"},{"value":"Urology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.urology.2025.06.070","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}