Peyronie’s disease after RP for prostate cancer: incidence and predictors


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.

10 Responses

  1. I recently ran a poll on my website on this issue (and other “minor” side effects). Whilst the poll has no scientific value, it may be of interest for men considering surgery.

    What is interesting is how few of the respondents were given any information about these issues before making their decisions. The substantial majority say that, had they known about the problems, they would still have chosen surgery.

  2. This is old news. My website has been running articles about RP and Peyronies for some time. If you want further information just enter prostatectomy in my search block.

  3. After a daVinci-assisted RP, I also now have Peyronie’s disease, which did not exist before prostate cancer surgery. I had significant infections after surgery, so I suspect the infections contributed to the Peyronie’s disease. I also still have ED and minor incontinence. The daVinci surgery performed was just the 10th procedure done by inexperienced doctor.

  4. I had RP surgery last year at age 45. I was very sexually active prior to surgery and suffered the usual incontinence and impotence post-op.

    As the incontinence cleared up, I pressed hard to get erections working again and tried to resume a regular normal sex life. I now believe that I am in the early stages of PD directly as a result of regularly attempting sex with a not fully erect penis. The base of my penis displays a constriction which is clearly evident when I have an “erection” but not when I visit my urologist (for obvious reasons). I had a scan and it revealed nothing, but I can clearly feel the build-up of plaque (or something) at the area of constriction.

    In my opinion a Cialis/Viagra-induced erection in a penis that is post RP focuses its “energy” on the top two-thirds of the penis, meaning that the base remains technically limp. Forcing such a lopsided penis into a vagina regularly and for sustained lovemaking causes the PD plaque to build up and as impotence heals and erections return to normality the natural strong erection becomes deformed due to the blockages in the penile blood vessels and spongy tissue.

  5. Well … You might want to get an appointment to see a real specialist in post-RP recovery of sexual function and run that hypothesis by him (or her). I am not aware of any data that specifically validate or refute such a hypothesis.

  6. There are some inaccuracies in how this study is described above. The subjects that were studied were men who had radical prostatectomy who presented to a sexual health clinic. These subjects were therefore men who were having ongoing difficulties with sexual perfomance, not the average man who had the surgery. So the citing the incidence of Peyronie’s disease for these subjects is not going to accurately portray the incidence for all men having the surgery. We find that this study is often misrepresented to say that 1 in 6 men having a radical prostatectomy will end up with Peyronie’s disease, when it clearly does not show this.

  7. Wendy, I have to disagree with your assessment. As I noted in my November 2010 post, my Peyronie’s disease was 100% as a result of the RP or infections caused by the RP; which was also confirmed by the physician.

  8. Dear Ms. Winnall:

    Please note that we very carefully did not generalize these data or make any statement about the overall incidence or prevalence of PD based on these data.

    We noted carefully that: (a) these were men presenting very specifically with sexual dysfunction and (b) “The incidence of PD within 3 years of treatment in this population was 15.9 percent.”

    Could we have made more emphatic statements 7 years ago about the fact that this study did not show that 1 in 6 men had PD post-surgery? Sure, but that is being wise after the event. We had no specific reason at the time to believe that others would misinterpret or misrepresent the data.

    We are well aware that many others misinterpret all sorts of data from all sorts of research (way beyond this one). However, we don’t believe there are “inaccuracies in how this study is described above”.

  9. Dear David:

    Ms. Winnall is absolutely not saying or suggesting that PD in a specific patient is not caused by radical prostatectomy.

    What she is pointing out is that it is not the case that 1 in 6 men get Peyronie’s disease after an RP. In that, she is completely correct. You might want to look at this article, which notes (among other things) that about 9% of men being screened for prostate cancer at a major medical institution in New York already had Peyronie’s disease at the time of screening (whether they were subsequently found to have prostate cancer or not). We really don’t know with any degree of accuracy what percentage of men get Peyronie’s disease after a radical prostatectomy, but it is pretty clear that it is well below 1 in 6. The patients studied in the above report were from a highly selected and very specific subset of men who had had an RP which is not representative of the entire set of men who have had an RP for first-line treatment of prostate cancer.

    Conversely, among those who do get PD after an RP, the PD can be severe and seriously problematic, and I am sorry to hear that you have suffered in this way.

  10. Hi Sitemaster,

    Thanks for clarifying. I was specifically referring to the phrases:

    “now published detailed data on the incidence of PD in in a series of > 1,000 patients after radical prostatectomy for prostate cancer”

    and

    “The total study population included 1,011 men who had received an 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.”

    These phrases indicate that the population in the study was men who had RP, and that the study was a measure of incidence in that population.

    Your clarification has set this straight, so thanks.

    I think these things need to be very carefully explained as the subtleties are lost on people who don’t know their epidemiology well.

    Wendy

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