About Your Fiducial Marker and Rectal Spacer Placement

This information will help you get ready for your procedure to have prostate fiducial markers and a rectal spacer placed. You’ll have this procedure before you start your prostate radiation therapy.

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About Your Prostate

Your prostate is a walnut-sized gland located below your bladder, directly in front of your rectum (see Figure 1). It surrounds your urethra, which is the tube that drains urine from your bladder. Your prostate adds fluid to your semen.

Figure 1. Your prostate anatomy

Figure 1. Your prostate anatomy

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About Fiducial Markers and Rectal Spacers

Fiducial markers are tiny metal objects (about the size of a grain of rice). They help your healthcare providers line up the beams of radiation and make sure your radiation therapy is delivered exactly the same way each time. This helps them target the tumor and avoid your nearby healthy tissue. The fiducial markers will stay in your prostate after your treatment.

You’ll get a rectal spacer called SpaceOAR hydrogel. SpaceOAR hydrogel is a gel that’s placed between your prostate and rectum to move your rectum away from your prostate. This protects your rectum from radiation and reduces some side effects of radiation therapy. The rectal spacer will stay in place for 3 months. Then, it’ll be absorbed by your body and come out in your urine.

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Before Your Procedure

Tell your healthcare provider if you:

  • Take an anticoagulant (blood thinner). Read the section “Ask about your medications” for examples.
  • Take any steroid medications (such as prednisone).
  • Take any dietary supplements (such as vitamins, herbal supplements, or natural or home remedies).
  • Have taken any antibiotics in the past 3 months.
  • Have any heart condition.
  • Have any implanted devices (such as knee or hip replacements).
  • Are allergic to the antibiotic ciprofloxacin (Cipro®) or any other medications.
  • Are allergic to latex.
  • Have had a urinary tract infection (UTI) in the last month.
  • Have ever had an infection or been hospitalized after a prostate biopsy.
  • Have had Achilles tendon injuries or tendonitis (inflammation of your tendons).
  • Have trouble hearing.
  • Work in a hospital or nursing home.

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your healthcare provider about which medications are safe for you to stop taking. We have included some common examples below.

Anticoagulants (blood thinners)

If you take a blood thinner (medication that affects the way your blood clots), ask the healthcare provider doing your procedure what to do. They may or may not tell you to stop taking the medication, depending on the reason you’re taking it.

Do not stop taking your blood thinner medication without talking with your healthcare provider.

Examples of Blood Thinners
apixaban (Eliquis®) dalteparin (Fragmin®) meloxicam (Mobic®) ticagrelor (Brilinta®)
aspirin dipyridamole (Persantine®) nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®) or naproxen (Aleve®) tinzaparin (Innohep®)
celecoxib (Celebrex®) edoxaban (Savaysa®) pentoxifylline (Trental®) warfarin (Coumadin®)
cilostazol (Pletal®) enoxaparin (Lovenox®) prasugrel (Effient®)  
clopidogrel (Plavix®) Fondaparinux (Arixtra®) rivaroxaban (Xarelto®)  
dabigatran (Pradaxa®) heparin (shot under your skin) sulfasalazine (Azulfidine®, Sulfazine®)  

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Read our resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E. It has important information about medications you might need to stop taking before your procedure and what medications you can take instead.

Pain medications and antianxiety medications

Tell your healthcare provider if you’re taking any pain medications or antianxiety medications. It’s important to keep taking these medications on schedule, even during your treatment. You may be able to take them on the morning of your procedure, if needed.

About sleep apnea

Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after your procedure.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device (such as a CPAP device) for sleep apnea, bring it with you the day of your procedure.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. Make sure to plan this before the day of your procedure.

If you don’t have someone to take you home, call one of the agencies below. They will send someone to go home with you. There’s usually a charge for this service, and you will need to provide transportation.

Agencies in New York                                         Agencies in New Jersey
Partners in Care: 888-735-8913                                         Caring People: 877-227-4649
Caring People: 877-227-4649                                          


Complete a Health Care Proxy form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. If you have completed one already, or if you have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent.

Talk with your healthcare provider if you’re interested in completing a health care proxy. You can also read the resources Advance Care Planning and How to Be a Health Care Agent for information about health care proxies, other advance directives, and being a health care agent.

Get your supplies

You’ll need to get the following supplies:

  • 2 saline enemas (such as Fleet® saline enemas). You can buy these at your local pharmacy without a prescription.
  • Ciprofloxacin (Cipro®) 500 mg tablets. This is an antibiotic (medication to help prevent an infection). Your healthcare provider will give you a prescription before your procedure.
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The Day Before Your Procedure

If you have any changes in your health or you need to cancel your procedure for any reason, call your primary radiation oncologist.

Note the time of your procedure

A staff member from the Admitting Office will call you after 2:00 pm the day before your procedure. If your procedure is scheduled for a Monday, they’ll call you on the Friday before.

The staff member will tell you what time to arrive at the hospital for your procedure. They’ll also remind you where to go. If you don’t get a call by 7:00 pm, call 212-639-5014.


Give yourself a saline enema

Give yourself a saline enema 2 hours before you go to bed. Follow the instructions in the package.

Instructions for eating

Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.


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The Day of Your Procedure

If your healthcare provider told you to take certain medications the morning of your procedure, take only those medications with a small sip of water.

Instructions for drinking

‌  Between midnight and up until 2 hours before your scheduled arrival time, you can drink a total of 12 ounces of water.

Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.


The morning of your procedure, shower like usual. Don’t put anything on your skin after your shower. This includes lotion, cream, deodorant, makeup, powder, perfume, and cologne.

Give yourself a saline enema

Give yourself a saline enema 3 hours before your procedure is scheduled to start. Follow the instructions in the package.


Things to remember

  • Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your procedure can cause burns if it touches metal.
  • Leave valuable items (such as credit cards and jewelry) at home.
  • If you wear contact lenses, wear your glasses instead. Wearing contact lenses during your procedure can damage your eyes. If you don’t have glasses, bring a case for your contacts.
  • If you wear dentures, you can wear them until you’re in the operating room. Make sure to tell the operating room staff that you’re wearing them before you fall asleep for your procedure.

Where to park

MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There’s a tunnel that you can walk through that connects the garage to the hospital.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Where to go

Your procedure will take place at Memorial Hospital (MSK’s main hospital). Its address is:

1275 York Avenue
(between East 67th and East 68th Streets)
New York, NY 10065

Take the M elevator to the 6th floor. Check in at the desk in the Presurgical Center waiting room.

What to expect

Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to say and spell your name and date of birth many times. This is for your safety. People with the same or similar name may be having a procedure on the same day.

When it’s time for your procedure, you’ll change into a hospital gown. A nurse will place an intravenous (IV) line into one of your veins, usually in your hand or arm. Then, a staff member will bring you to the operating room. Once you’re comfortable, you’ll get anesthesia (medication to make you sleep during a surgery or procedure) through your IV.

Once you’re asleep, your healthcare provider will use rectal ultrasound to see your prostate. They’ll put tiny needles into your prostate through your perineum (the area of skin between your scrotum and anus).

Your doctor will place 3 fiducial markers into your prostate through the needles and then will remove the needles. Then, your doctor will inject the rectal spacer gel into the space between your prostate and rectum using a needle.

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After Your Procedure

In the hospital

When you wake up, you’ll be in the Post Anesthesia Care Unit (PACU). You’ll stay there until you’re fully awake and can urinate (pee) without any trouble. A nurse will talk with you and your caregiver and give you your discharge instructions

At home

You might have a feeling of fullness in your rectum for the 2 days after your procedure. This is normal and won’t affect your bowel movements.

Don’t put anything in your rectum for 3 months after your procedure. If your healthcare provider tells you to give yourself an enema before any of your radiation treatments, it’s OK to do so.


Medication instructions

Start taking ciprofloxacin the night after your procedure. Keep taking it every 12 hours for the following 3 days. This will help prevent an infection in your prostate.

If you have any pain, you can take an over-the-counter (not prescription) pain medication, such as acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®).

Physical activity and exercise

You can drive and do your normal activities 24 hours after your procedure.

Don’t lift anything heavier than 10 pounds (4.5 kilograms) for 1 week after your procedure.

Eating and drinking

You can go back to your usual diet right away after your procedure.

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When to Call Your Healthcare Provider

Call your healthcare provider right away if you have:

  • Increasing pain or pain that doesn’t get better after taking over-the-counter pain medication
  • A fever of 100.4 °F (38 °C) or higher
  • Chills
  • Trouble urinating
  • Blood in your stool (poop) or urine (pee)
  • Dizziness
You can reach the healthcare provider who placed your markers and rectal spacers Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the person on call for your healthcare provider.
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Helpful Phone Numbers

Call with any questions about anesthesia.

Bobst International Center
MSK welcomes patients from around the world. If you are an international patient, call for help coordinating your care.

Patient Billing
Call Patient Billing with any questions regarding preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
Call if you have any questions about the Health Care Proxy form or if you have any concerns about your care.

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