Men choosing prostate cancer treatment should be informed about the small risk for penis shrinkage, say US researchers who believe discussing the rare side effect could reduce the chance for patient regret.
Overall, 25 (2.63%) of 948 US men complained of a reduction in penis size a median of 5.5 years after receiving treatment for biochemical failure, show data from the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry.
A reduction in penile size was reported by 3.7% of the 510 men who underwent surgery and 2.7% of the 225 men who underwent radiotherapy plus androgen deprivation therapy (ADT). By contrast, none of the 213 men who received radiotherapy without ADT complained about a change in penis size.
Men who reported penile reduction were a significant 2.36 times more likely to experience interference in close emotional relationships than those who did not have the side effect, after adjusting for age, treatment, and comorbidity.
Affected men were also a significant 3.37 times more likely to regret their treatment choice, and a trend to reduction in overall enjoyment of life was near to significance, report Paul Nguyen (Dana-Farber Institute, Brigham and Women's Hospital, Boston, Massachusetts) and co-authors.
"Prostate cancer is one of the few cancers where patients have a choice of therapies, and because of the range of possible side effects, it can be a tough choice," said Nguyen in a press release.
"This study says that when penile shortening does occur, it really does affect patients and their quality of life. It's something we should be discussing up front so that it will help reduce treatment regrets."
In a commentary accompanying the study in Urology, Luc Cormier (Dijon University Hospital, France) writes that "penile length trouble is often discussed in clinical practice, and physician[s] should be aware of the necessity of informing patients of the possible risk."
He acknowledges the difficulties surrounding accurate penis measurement due to patient perception of penile length and the impact of disease recurrence on that perception. Cormier concludes that future studies should determine the relationship between sexual activity and patient perception of penile length to get a true picture of treatment impact.
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