Peyronie's Progression with Time

Peyronie's Disease is often classified as being either in the "acute" or "chronic" phase.  These terms refer to the period of time when the disease is still changing ('acute') compared to when it has stabilized ('chronic').  Although most Andrologists (clinicians specializing in male sexual health) agree with the concept of acute versus chronic, the exact timeline for what defines the acute phase is very debatable.

Historically, the "acute" phase was defined as 6-12 months following disease onset.  It was believed that after this amount of time, few changes continued to occur.  This timeline also established the minimum time that was recommended prior to considering surgical repair.  This minimum was established since it would be counterproductive to surgically repair curvature, only to have it return a few months later and require a repeat operation.  

There are a few studies that have helped to better understand the difference between acute and chronic phases of disease.  Dr. John Mulhall performed a study where he compared outcomes of men who were seen within 6 months of disease onset and then were again seen at least 12 months after the disease started.(1)  In the study, he found that during the time from the first visit to the second one, curvature had worsened overall, the length had decreased, and erectile function had worsened.  Also, the percentage of men complaining of length loss, difficulty penetrating, and inability to penetrate increased.  Here is a graph demonstrating these findings.

The same study showed that overall, men reported that from the first to the second visit, the disease had improved in 12% of cases, remained stable in 40%, and worsened in 48%.  

Other studies have suggested that the disease likely continues to change over a period of several years.  Martin Gelbard performed a study in 1990 where he compared men who were within the first 2 years of disease to those who were 4 years or more out from the onset.(2)  In the study, he showed that the 4+ year group reported higher rates of improved pain, curvature, and overall improvement compared to those who were within the first two years.   

Our group performed the longest-term follow-up of men with Peyronie's Disease (median duration 8.4 years).(3)  Overall, we found that at latest follow-up, 34% of men felt that their condition had improved over time, while 26% felt that it worsened (since the initial disease began).  Curvature resolved in 43%, and 65% reported penile shortening.  

A fourth study worth mentioning is a penile traction study performed by Dr. Martinez-salamanca and colleagues.(4)  In this study, men with Peyronie's Disease less than 6 months used Andropenis for several hours daily.  Results showed improvements in length and curvature compared to those who didn't use therapy.  However, the improvements were only noted among men who started the therapy within the first 3 months. 

Taken together, these studies suggest that the disease continues to evolve in some individuals for many years after the original disease onset. 

(My interpretation / opinion) is that the true "acute" phase, where the disease is modifiable, is likely very short.  With most other disease processes in the body (e.g. trauma, surgery, infection, others), the first 4-6 weeks are the most critical for healing.  As such, any therapy designed to modify the overall disease (e.g. traction) is likely best used as soon as possible after disease onset.  This concept of waiting 12 months before you do anything is likely incorrect and does a great disservice to patients.  It is our opinion as well that factors that suggest that the disease is still modifiable includes penile pain (continuing inflammation) and ongoing changes in curvature.  Once the disease has stabilized though, the outcomes of treatment are likely similar, regardless if the treatment is pursued immediately or in a delayed manner (end of opinion).

References: (1) Mulhall JP, et al: 2006 J Urol; (2) Gelbard MK, et al: 1990 J Urol; (3) Ziegelmann MJ, et al: 2018 Urology; (4) Martinez-salamanca JI, et al: 2014 J Sex Med.

Pain that occurs with Peyronie's Disease is thought to be due to inflammation.  The presence of pain typically means that the disease process is still changing in some way.  Some men will never experience penile pain, while others may experience it for months or even years. 

As noted earlier, pain improves in all men over time, regardless if any treatment is provided.  One study that evaluated the change in pain over time reported that among men who were 2 years or less from the time of disease onset, approximately 18% had no pain, while 22% had initial pain that worsened, 47% had pain that remained stable, and 9% had a worsening of pain over time.(1)  In that same study, among men who were 4 years or more out from their initial disease onset, approximately 35% of men had no pain, 18% were better, 41% were the same, and 4% had worse pain.  When you combine these two groups, it shows that more men overall had ongoing improvements in pain.

A second study performed by our group looked at men who were a median 8.4 years out from their disease onset, and it showed that approximately 66% of men reported complete pain resolution, while 16% had improved pain, 12% unchanged, and 7% worsened.(2)  As this is the longest-term study performed to date, it suggests ongoing improvements with time.  However, it also highlights how it may take several years for pain to improve for some individuals.

References: (1) Gelbard MK, et al: 1990 J Urol; (2) Ziegelmann M, et al: 2018 Urology

As with other aspects of Peyronie's Disease, penile curvature typically changes with time.  Curvature is likely most actively changing early on in the disease course, while it tends to stabilize over time.  In a study of men who were in the "acute" phase of disease (defined as within first 6 months in this study), curvature increased by an average of 17 degrees over the next 6-12 months.(1)  Over that same time period, 12% of men reported that the curvature had improved, while 40% said it remained the same, and 48% reported worsening. 

In a second study of men who were in their first two years of disease, none of the men had complete resolution, while approximately 6% had improvements, 52% were stable, and 40% had a worsening of curvature.(2)  By the time men were 4 years or greater from their disease onset, 0% had complete curve resolution, 22% had improvement, 41% said they were the same, and 34% said the curve had worsened.  

In our long-term series of men who were a median 8.4 years out from disease onset, 24% of men reported complete disease resolution, 25% improvement, 32% unchanged, and 22% worsening.  

When all of these studies are combined, it suggests that early in the disease course, the curvature initially worsens, but then with longer follow-up (years), most men will either report curve stability or improvement over time.  

References: (1) Mulhall JP, et al: 2006 J Urol; (2) Gelbard MK, et al: 1990 J Urol; (3) Ziegelmann M, et al: 2018 Urology

Although penile length loss is clearly associated with Peyronie's Disease, the time course for length loss is not well understood.  In a study of men who presented within their first 6 months of disease onset, Dr. Mulhall's group noted that men initially had an average penile length of 12.2 cm.(1)  Once these same men were 12 months or more out from the disease onset, their average lengths were 11.4 cm, suggesting ongoing loss even after the first 6 months.  

In our series of men who were a median 8.4 years out from their disease onset, 64% of men reported penile shortening, however, no objective measurements or data were obtained.(2)  To our knowledge, no other studies have performed repeated penile length measurements over time to accurately characterize how the disease impacts penile length.  

References: (1) Mulhall JP, et al: 2006 J Urol; (2) Ziegelmann M, et al: 2018 Urology