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. 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.

Health-Related Quality of Life in Advanced Prostate Cancer and Its Treatments: Biochemical Failure and Metastatic Disease Populations

“…One novel concept identified in the study, genital atrophy, appears to be very common, yet this adverse effect has only recently been defined in the literature. 18 Results from this study were used to develop a comprehensive conceptual model depicting the impacts of prostate cancer and its treatment. Conceptual models are useful for identifying key endpoints for clinical studies, as well as for developing or selecting PROs to assess key endpoints.…”

The Prevalence and the Use of the Questionnaire’s Related to the Neglected Sexual Side Effects After Prostate Cancer Treatment: A Scoping Review of the Literature

“…The 2017 study reported that 42% of participants reported more than 1 cm subjective PLS. 4A 2013 study by Parekh and colleagues of men (n = 948) mostly aged between 60-80 who reported selfperceived PLS (35). The study participants consisted of 22, 5% RT participants.…”

“…A 2018 study based their results on the physical measurement of PLS (32). Parekh et al;(2013) reported in their study that physicians completed a questionnaire based on their patients, one question noted under the complaints section referred to reduced penile size (35). No physical measurements were reported on.…”

“…PLS was reported found in two RT studies (4,35), and eight RP studies (5,(32)(33)(34)(35)(36)(37)(38). The one study reported on both RT and RP, and concluded that no RT participants had PLS (35). PLS was worst at 7-10 days postoperatively (32, 33), but started recovering at 3-6 months (38).…”

“…Men who eventually do not fully regain their PL, can experience up to a 24% PL loss at 7 days postoperatively (32). Younger age and better pre-operative erectile function is associated with complete PL recovery (32), and PLS is associated with treatment regret (35).…”