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Introduction We report a case of rectal perforation following SpaceOAR placement utilized with iodine‐125 low‐dose‐rate brachytherapy for prostate cancer. Case presentation 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. Conclusion 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.