Journal of Urology Article Reduced Penis Size
and Treatment Regret With Recurrent Prostate
Cancer After Surgery, Radiotherapy Plus
Androgen Deprivation Therapy (ADT), or
Radiotherapy Alone. Gets Widespread Publicity,
Contradicts Other Studies - Are Treatment Side
Effects Even Worse? All Studies Agree On One
This article appeared in 2012 and received a great deal of media
attention, much of it joking about penis size after prostate cancer
treatment. Here are just 3 links to news stories discussing this
medical journal article. I could cite dozens.
In February 2004, the Comprehensive, Observational, Multi-
center, Prostate Adenocarcinoma (COMPARE) Registry was
opened across 150 different cities in the United States. This
observational, prospective database was initiated with the goal of
collecting data on men with biochemical recurrence after primary
therapy for prostate cancer. Essentially, recurrence referred to
men who had been treated for non-metastatic prostate cancer
and subsequently, exhibited increasing levels of PSA.
For inclusion in the study, there had to be complete information
on their history and they had to perceive themselves as having
penile shrinkage after prostate cancer treatment. They had to
have been diagnosed with prostate cancer and treated by radical
prostatectomy, radiation therapy, or radiation therapy + androgen
deprivation therapy (ADT). A total of 948 men met the criteria
and were included in the study. Here is a breakdown:
The researchers also report that those men who reported penis
shrinkage had treatment regret. This adverse event interfered
with their intimacy. It appears that physicians rarely mention this
adverse event when discussing prostate cancer treatment with
To their credit, researchers noted that other studies have
reported a much greater percentage of men reporting significant
decrease in length. In the other studies, men also reported a
much greater loss of penis length after prostate cancer
treatment. One study by Savoie et al reported significant
decreases in length and girth. Another study noted that after
ADT alone penile length shrunk by approximately 2.5 cm.
The authors concluded that “perhaps more striking” was that a
shrunken penis had a significant effect on patient regret as
regards to treatment and the quality of his close emotional
relationships. The authors counseled that physicians should be
sure to discuss this with their patients prior to treatment so they
can make informed decisions. In response to this article, one
physician from France wrote in and stated that clinicians often
discuss this adverse event among themselves. They should
make sure patients are informed of this potential outcome.
In yet another study, Brazilian physicians studied the natural
history of penile length long term after a Radical Prostatectomy.
These physicians measured penile length in their office starting
at 3 months after treatment through 5 years post prostatectomy.
One hundred and Five (105) men were included in the study
provided that they had not undergone any penile rehabilitation,
such as Vacuum Therapy. Also excluded were men with a prior
diagnosis of Peyronies Disease.
- The article noted that penile shrinkage was a common complaint in
men who had undergone prostate cancer surgery
- Estimated prevalence as high as 70% based on other studies
- No patients presented palpable plaques or other penile anomalies
during follow up
Penile shortening of approximately 1 cm may be expected for up
to 12 months. A trend towards full recovery begins at
approximately 24 months and full recovery can be expected by
month 48. Preservation of erectile function is a predictor of early
My Comments - There is so much I want to say about these
articles, I don't know where to begin.
This site is about Peyronies Disease, why am I writing about
prostate cancer and penis shrinkage after treatment? There are
3 variables to consider:
- There is (or there was) significant evidence to link prostate cancer
treatment with an increased incidence of Peyronies Disease.
- All but the mildest cases of Peyronies result in penis shrinkage, both
length and girth
- Penis shrinkage can occur after prostate cancer treatment even if
there is no development of Peyronies.
I have written extensively about the increased incidence of
Peyronies Disease after prostate cancer treatment. A report in
Medical News Today July 02, 2008, noted that close to 20% of
men developed Peyronies after prostate cancer surgery. The
first Journal of Urology article on this page discussed shrinkage,
but no mention of Peyronies. Could it possibly be that it was
simply left out because it was not the topic of research? The 2nd
article discussed on this page does note that men were
examined for penile plaque, which would be an indication of
Peyronies. Again, no mention of Peyronies. The first research
report was based on a 5 year post prostate cancer treatment
follow-up and reported loss of length after 5 years, but the 2nd
report indicated return to normal length with complete recovery
by 48 months.
I have written
Cancer. If you are
interested in this
topic, just type
prostate cancer in
the search box.