title: Reduced penile size and treatment regret in men with recurrent prostate cancer after surgery, radiotherapy plus androgen deprivation, or radiotherapy alone.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Arti
authors.initials: A
authors.lastname: Parekh
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Oliver
authors.initials: O
authors.lastname: Sartor
authors.forename: Karen
authors.initials: K
authors.lastname: Stein
authors.forename: Powell L
authors.initials: PL
authors.lastname: Graham
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000523:psychology; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000523:psychology; D016001:Confidence Intervals; D004644:Emotions; D006801:Humans; D007398:Interpersonal Relations; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009929:Organ Size; D017060:Patient Satisfaction; D010413:Penis / Q000473:pathology*; D010465:Perception; D011468:Prostatectomy / Q000009:adverse effects / Q000523:psychology; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D011788:Quality of Life / Q000523:psychology*
chemical_list: D018931:Antineoplastic Agents, Hormonal