Peyronie's Disease and Radical Prostatectomy: Is There a Link?
Peyronie's Disease is a disorder of the connective tissue within the penis that can cause curvature during erection. It's fairly rare -- diagnosed in only 26 out of 100,000 men each year, most of them in their fiffies and sixties. But Hopkins urologists have spotted what they believe may be a small yet significant trend: Peyronie's Disease seems to be more common in men who have had a radical prostatectomy. Is this just coincidence? The age group is roughly the same. Or does the procedure itself -- or a man's recovery from it--somehow contribute to development of the disease?
"Peyronie's Disease is like arthritis of the penis," says urologist Jonathan P Jarow, M.D., who specializes in treatment of erectile disorders. "When you get scar tissue deposited in the connective tissue of your joints, you get arthritis. It's a similar problem in the penis," Sometimes this buildup of scar tissue causes a telltale bend, or curvature in the penis (which appears only during erection). It may also manifest itself as palpable or painful lumps -- which may be terrifying for a man to discover. "Many men worry that they have penile cancer," says Jarow, "but we can tell just by examining them exactly what it is." He hastens to reassure his patients that although the disorder may be annoying, it is not life-threatening: "Men aren't going to live any longer or shorter because of it."
Although nobody knows what causes Payments's disease, scientists believe that it's related to a series of minor injuries -- or, as Jarow explains, "wear and tear." One theory "is that it's due to repetitive, minimal trauma to the penis from buckling that occurs when you're attempting sexual relations with an incomplete erection, and that this repetitive trauma leads to buildup of scar tissue." Peyronie's disease appears to be more common among men who have erectile dysfunction, notes Jarow. "It's not clear whether it's secondary to some of the treatments, such as vacuum erection devices, or injection therapy, or whether it's due to having erection problems to begin with, and is independent of the treatment."
In a new study, led by Jarow and Patrick C. Walsh, M.D., that will include 100 patients, 3 out of 64 radical prostatectomy patients so far have developed "rapid appearance of new-onset Peyronie's disease" after surgery, says Jarow. "This sounds very low. But if you compare that to the incidence of Peyronie's disease in the general population, it's 1,000-fold greater.
In some men there may be an inherited component to Peyronie's disease ( as there is with other tissue disorders); Jarow is seeking men with a family history of the disease in hopes of finding genetic proof "What makes us so interested in the radical prostatectomy patients and we are just beginning to investigate this -- is that, hopefully, if we can understand the mechanism behind Peyronie's disease in this setting, we may be able to prevent it in men undergoing radical prostatectomy in the future, as well as in other men."
The good news is that Peyronie's disease does not progress forever. "In some men (fewer than 20 percent), it goes away by itself," says Jarow. "For most people, it eventually stabilizes. The pain goes away. The lump becomes less prominent, and the curvature lessens. In just about everybody, the disease process, the deposition of scar tissue, stops with time."
Men who were fully potent when the disease began generally remain so, Jarow notes. "In other words, erection problems -- specifically problems with rigidity -- are a rare end result of Peyronies disease in general." But most men who have had a radical prostatectomy have at least some temporary trouble with erection; thus, treatment depends on a man's specific symptoms. "If a man's problem is curvature -- if the penis is bent so he cannot engage in sexual activity, or it's uncomfortable to his partner -- then we can do an outpatient surgical procedure to straighten the penis," says Jarow. "If, however, he has significant curvature that prevents sexual relations and problems with rigidity, then he's treated with insertion of a penile prosthesis combined with penile straightening," also an outpatient procedure. If a man simply has erection problems but no serious curvature, he is "treated like anyone else with an erection problem, starting with pills, then shots, then the vacuum device, then if necessary, a penile prosthesis."
We are trying to learn more about this condition in men who have undergone a radical prostatectomy. If you have Peyronies' disease and would like to help us, or to find out more about this work, please write to Dr. Jarow at The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD 21287-2101.