Radiation therapy in Peyronie's disease.
BACKGROUND
Peyronie's disease (PD) is characterized by fibrotic plaque formation within the tunica albuginea, leading to penile deformity, angulation, painful erections, and often, erectile dysfunction. There is limited knowledge of its etiology and pathophysiology. Currently, there is no standardization for reporting the evaluation and treatment outcomes. No consensus exists on the ideal management of PD.


OBJECTIVE
The aim of this study is to review the use of radiation therapy (RT) for the treatment of PD.


METHODS
This study used a review of the literature and informed expert opinion.


METHODS
The main outcome measures are the reported improvement with regard to pain, curvature, plaque size, and erectile function as well as a review of the safety profile of RT.


RESULTS
Radiation has been used for the empirical treatment of PD with mixed results throughout the literature. Low-dose RT in the early stages of PD seems to be effective in patients with painful erections not improving with time or with the use of oral or intralesional therapies. Comparison with other current medical therapies is difficult due to the absence of criteria for therapeutic success and the absence of randomized, controlled trials. Multiple studies have demonstrated varied results in terms of curvature reduction, plaque volume, and sexual functioning. The absence of the use of validated means of measuring penile deformity and sexual function, the limited relevance of plaque and pain improvement combined with the potential negative consequences of radiation on erectile tissue structure and function lead us to make a recommendation that RT not be used for the management of PD.


CONCLUSIONS
In clinical practice, mixed success for RT has led to the recommendation against its use as a treatment modality for PD.
Male Sexual and Reproductive Medicine Program, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. mulhalj1@mskcc.org
John P
JP
Mulhall
Matthew
M
Hall
Gregory A
GA
Broderick
Luca
L
Incrocci
D006801:Humans; D008297:Male; D010410:Penile Erection / Q000528:radiation effects; D010411:Penile Induration / Q000532:radiotherapy*; D010413:Penis / Q000528:radiation effects; D016896:Treatment Outcome