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Reduced Penile Size and Treatment Regret in Men With Recurrent Prostate Cancer After Surgery, Radiotherapy Plus Androgen Deprivation, or Radiotherapy Alone

      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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      References

      1. SEER. Surveillance Epidemiology and End Results Program. Available from: www.seer.cancer.gov. SEER*Stat Database: Incidence—SEER 17 Regs Limited-Use, November 2008 Sub (1969-2006 varying)—Linked To County Attributes—Total U.S., 1969-2006 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. Released April 2009, based on November 2008 submission.

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      Linked Article

      • Editorial Comment
        UrologyVol. 81Issue 1
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          The 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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