Objective
To report the relative incidence of the perceived reduction in penile size across
prostate cancer treatment modalities and to describe its effect on quality of life
and treatment regret.
Materials and Methods
The incidence of patient complaints about reduced penile size was calculated for 948
men in the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE)
registry who experienced biochemical failure (per registry definition) and were assessed
a median of 5.53 years after prostatectomy or radiotherapy (RT) consisting of either
external beam RT or brachytherapy, with or without androgen deprivation therapy (ADT).
Multivariate logistic regression analysis was used to determine the factors associated
with treatment regret and interference with emotional relationships.
Results
Of 948 men, 25 (2.63%) complained of a reduced penile size. The incidence of reduced
penile size stratified by treatment was 3.73% for surgery (19 of 510), 2.67% for RT
plus ADT (6 of 225), and 0% for RT without ADT (0 of 213). The surgery (P = .004) and RT plus ADT (P = .016) groups had significantly more shortened penis complaints than the RT alone
group. The rate of a shortened penis after surgery and after RT plus ADT was similar
(P = .47). On multivariate analysis adjusting for age, treatment type, and baseline
comorbidity, a perceived reduction in penile size was associated with interference
with close emotional relationships (odds ratio 2.36, 95% confidence interval 1.02-8.26;
P = .04) and increased treatment regret (odds ratio 3.37, 95% confidence interval 1.37-8.26;
P = .0079).
Conclusion
Complaints about a reduced penile size were more common with RT plus ADT or surgery
than RT alone and were associated with greater interference with close emotional relationships
and increased treatment regret. Physicians should discuss the possibility of this
rarely mentioned side effect with their patients to help them make more informed treatment
choices.
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Article info
Publication history
Accepted:
August 6,
2012
Received:
April 25,
2012
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This work was supported by an anonymous family foundation, the Doris Duke Charitable Foundation Clinical Research Fellowship at Harvard Medical School, David and Cynthia Chapin, Fitz's Cancer Warriors, and a Heritage Medical Research Institute/Prostate Cancer Foundation Young Investigator Award.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- Editorial CommentUrologyVol. 81Issue 1
- PreviewThe authors present an interesting viewpoint about changes in penile length after prostate cancer treatment (RP, external beam RT or brachytherapy with or without ADT) in men who experienced biochemical failure after initial treatment. Of their patients, 2.63% complained of a reduced penile size. This report is really of interest because of the number of patients and that it included other treatment methods in addition to RP. Penile length trouble is often discussed in clinical practice, and physician should be aware of the necessity of informing patients of the possible risk.
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