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        WHAT THE CURRENT EVIDENCE SHOWS

Let’s look at the data.  There is no universally accepted estimate of
the number of men who have PD.  However, because of the
embarrassing nature of this disease and men’s reluctance to report
when they have it, virtually every researcher believes that the data
significantly underestimates the incidence of PD.  Keep this in
mind when reviewing the PD incidence rate.

  • According to Volume 5, Winter 2000 edition of the James
    Brady Urological Institute at Johns Hopkins University (JHU),
    Prostate Cancer Update, researchers spotted what they
    believe was a significant trend.  A small number of patients in
    their study developed a rapid appearance of new onset PD
    after their RP.  The incidence of men who developed "this rare
    disorder" after a RP was a 1,000 fold increase as compared to
    men in the general population.

  • Medical News Today, 02, June 2008, reported on a
    retrospective review of 589 men who had their prostate cancer
    treated by a RP.  Of these men. 102/589 developed PD for an
    incidence rate of 17%.  Mean curvature was 32 degrees.  No
    mention was made if they were measured for loss of penile
    dimensions.

  • The Los Angeles Times of 02, September 2009, ran an article
    about penile health.  Dr. Tom Lue, a professor of urology at the
    UCSF was interviewed.  The article notes that the exact
    incidence of PD was tough to estimate, but the range was 1-
    24% of the adult male population. The body relies on blood
    flow to repair damaged tissue without leaving a scar, yet there
    is very little blood circulation in the penis, except when it is
    erect.  As a result, when a man overdoes it and injures his
    penis, excessive scar tissue builds up over the elastic layers
    of the penis over time. My comment -This is Peyronies.  In
    discussing PD, the article also states that healing from
    prostate surgery can cause problems.    

In an article that appeared  in the publication, European Urology
(52) 2007, (and in a follow up interview which appeared in Modern
Medicine, 01 August 2009) the author, Dr. John Mulhall of the
Department of Urology at Memorial Sloan Kettering Hospital poses
this question to readers.  "How often have you, as a urologist,
heard men complain of loss of penile length or girth following a
RP?  Despite the frequency of prostate cancer and RP as a
treatment, Dr. Mulhall stated there have only been 3 small studies
to examine the correlation between RP, loss of length/girth and the
development of PD.

  • By McCullough 1999 - 100 men participated.  All showed
    decrease penile dimensions; both length and girth.

  • By Munding 2001 – 31 patients were enrolled.  All were
    measure 3 months post op and 71 showed decreased length
    and 15/31 showed considerable shortening. Note – the  article
    abstract does not mention girth, but the complete article may.

  • By Savoie.  A total of 124 men were enrolled. Post RP, 68% has
    some degree of loss of penile length.  The size of the penis
    was significantly smaller after surgery.  Nerve sparing surgery
    was not a significant factor in change dimensions in stretched
    penile dimensions.  Dr. Savoie concluded that men should be
    counseled prior to surgery and be informed about the
    possibility of post op shortening.   

  • Although Dr. Mulhall mentioned that there were only 3 studies,
    I found a 4th one that was conducted in Torino, Italy PMID
    reference 17570431.  The study enrolled 126 consecutive
    patients.  Their conclusion was that penile shortening after RP
    peaked at the time of catheter removal and continued to a
    lesser, but still significant degree for at least 1 year.  The
    researchers advised that this side effect should be taken into
    consideration when counseling patients for RP.

Let's be clear so there is no misunderstanding.  As a result of lack of
research there are currently no conclusive findings concerning post
RP development of PD and/or decrease of penile length and girth.  
However, strong anecdotal evidence and findings from a few studies
and surveys are strongly suggestive of the following concerning
post RP patients:

Men experience a significant increase in the incidence of
newly reported PD following a RP.  My estimate is that 6-8% of
adult men in the total U.S. population have PD, Therefore,
based on the previous study, having a RP approximately
doubles the incidence rate to 17%.

An even greater percentage of men without a diagnosis of PD
develop a post  RP decrease in penile volume; lose of length
and girth.      

Dr. Mulhall speculated that penile volume loss can be explained by
3 main pathologic events in the penis. 1) fibrogenic cytokines,
collagenization.   My Comment - these changes would be associated
with Peyronies Disease.  2) hypoxia induced structural changes to
the penis and 3) competitive sprouting.  

If these symptoms develop independent of each other, this would
explain why post RP some men develop PD and a greater percentage
experience lose of penile length and girth.