Peyronie’s disease (PD) is a clinical condition characterized by an upward curvature of the erect penis. It is known to occur with regularity in men between about 45 and 75 years of age. A thorough overview of this condition by Lizza can be found on the eMedicine web site.
What we really don’t know so much about includes:
- The true incidence and prevalence of PD
- Exactly what causes this condition
- Whether there is a specific association between treatment for prostate cancer (by radical prostatectomy) and increased risk for PD.
Because reported cases of PD occur with highest frequency in men in their 50s and 60s (the same age range as that at which prostate cancer starts to become common), there has long been a strong suggestion that there is an association between treatment for prostate cancer with radical prostatectomy (RP) and risk for PD. However, the actual evidence that RP increases risk for PD has been very limited.
Historically, PD was not something most men rushed to their doctors to talk about. It’s symptoms may be mild and have little impact on men’s lives. It may be preceded by erectile dysfunction. It is also commonly preceded by and associated with painful erections. But it is an embarrassing condition for most men, and so if they have never been to their doctor for another urological condition, they may only mention this when it becomes a significant problem.
Thus, from an epidemiological point of view, all we really know is that the reported rate of PD in men as a whole is around 0.5 to 3 percent, although Mulhall et al. reported a prevalence of 8.9 percent in a series of men being screened for prostate cancer.
Tal et al. have now published detailed data on the incidence of PD in in a series of > 1,000 patients after radical prostatectomy for prostate cancer and have made an initial attempt to determine possible predictors of the occurrence of after an RP.
Between 2000 and 2008, researchers at Memorial Sloan-Kettering Cancer Center developed a sexual medicine database, focused primarily on men who were treated with an RP as their primary therapy for localized prostate cancer. Tal et al. then used this database to identify patients who developed PD within 3 years of their RP and compared them with the patients who did not.
The results of this study show the following:
- The total study population included 1,011 men who had received and RP as their only treatment for localized prostate cancer.
- The incidence of PD within 3 years of treatment in this population was 15.9 percent.
- The average (mean) time to development of PD after RP was 13.9 ± 0.7 months.
- The average (mean) curvature was 31 ± 17 degrees.
- Younger age showed a somewhat higher risk (hazard ratio [HR] = 1.3) for PD after RP.
- White race showed a much higher risk (HR = 4.1) for PD after RP than non-white.
- Post-operative erectile function was not a predictor of PD development.
The authors conclude that, “Men presenting with sexual dysfunction after RP have higher PD incidence then the general population” and that “Younger men and men of white race are at increased risk for PD” after an RP.
However, it is notable that the authors still do not conclude from this study that RP is a specific cause of PD. Indeed, they state specifically that additional studies will be needed “to conclude if RP has a causative role in the pathogenesis of PD.”
There seems to be little doubt that RP is at least a potential and significant risk factor for PD in some groups of men, and the authors recommend that RP patients should be monitored post-surgery for PD. Having said that, it should be noted that effective treatments for PD are limited in their value , and most men with PD should be carefully monitored in the early stages of the disease as opposed to taking any immediate, radical steps to correct the condition.
Peyronie’s disease (PD) is a clinical condition characterized by an upward curvature of the erect penis. It is known to occur with regularity in men between about 45 and 75 years of age. A thorough overview of this condition by Lizza can be found on the eMedicine web site.
What we really don’t know so much about includes:
Because reported cases of PD occur with highest frequency in men in their 50s and 60s (the same age range as that at which prostate cancer starts to become common), there has long been a strong suggestion that there is an association between treatment for prostate cancer with radical prostatectomy (RP) and risk for PD. However, the actual evidence that RP increases risk for PD has been very limited.
Historically, PD was not something most men rushed to their doctors to talk about. It’s symptoms may be mild and have little impact on men’s lives. It may be preceded by erectile dysfunction. It is also commonly preceded by and associated with painful erections. But it is an embarrassing condition for most men, and so if they have never been to their doctor for another urological condition, they may only mention this when it becomes a significant problem.
Thus, from an epidemiological point of view, all we really know is that the reported rate of PD in men as a whole is around 0.5 to 3 percent, although Mulhall et al. reported a prevalence of 8.9 percent in a series of men being screened for prostate cancer.
Tal et al. have now published detailed data on the incidence of PD in in a series of > 1,000 patients after radical prostatectomy for prostate cancer and have made an initial attempt to determine possible predictors of the occurrence of after an RP.
Between 2000 and 2008, researchers at Memorial Sloan-Kettering Cancer Center developed a sexual medicine database, focused primarily on men who were treated with an RP as their primary therapy for localized prostate cancer. Tal et al. then used this database to identify patients who developed PD within 3 years of their RP and compared them with the patients who did not.
The results of this study show the following:
The authors conclude that, “Men presenting with sexual dysfunction after RP have higher PD incidence then the general population” and that “Younger men and men of white race are at increased risk for PD” after an RP.
However, it is notable that the authors still do not conclude from this study that RP is a specific cause of PD. Indeed, they state specifically that additional studies will be needed “to conclude if RP has a causative role in the pathogenesis of PD.”
There seems to be little doubt that RP is at least a potential and significant risk factor for PD in some groups of men, and the authors recommend that RP patients should be monitored post-surgery for PD. Having said that, it should be noted that effective treatments for PD are limited in their value , and most men with PD should be carefully monitored in the early stages of the disease as opposed to taking any immediate, radical steps to correct the condition.