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Is there a new role for oral therapy to treat peyronie’s disease? Commentary on Daily low-dose tadalafil may reduce the penile curvature progression rate in patients with acute Peyronie’s Disease: a retrospective comparative analysis

International Journal of Impotence Research volume 36, pages 160–161 (2024)Cite this article

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In their article published in this months issue of International Journal of Impotence Research, Spirito et al. sought to evaluate the impact of low dose oral tadalafil on the rate of penile curvature progression in patients with acute phase PD [1]. Treatment for Peyronie’s Disease (PD) was first described by the condition’s namesake in 1743 [2]. Interesting examples of some rather esoteric treatments over the last 250 years include mercury, arsenic, electricity, and various forms of radiation [3]. Modern non-surgical approaches have involved various oral and intralesional agents with mechanisms of action that are purported to target anti-inflammatory and anti-fibrotic pathways [4]. To deliver an oral medication to a specific tissue of interest, there needs to be adequate vascularity of the target tissue. Scar vascularity has been studied in other areas of the body such as the skin after superficial burns. Neovascularization appears to happen to some extent in many scars, although the extent of neovascularization is heterogenous and this is challenging measure [5]. Thus, while from a mechanism standpoint it makes sense to consider oral medications, in practice the actual ability of that medication to travel to the target tissue (i.e. penile plaque) and exert its effects is unclear. One must also consider that most of these agents target steps along inflammation and fibrosis pathways, so there is important to get these medications delivered prior to the scar setting in. The classic dichotomy of defining PD in the acute/active and chronic/stable phases is largely based on clinical picture rather than what is happening at the cellular level, which further complicates treatment protocols and timing [6].

Among published guidelines for PD, there is nearly universal consensus that most oral agents should not be used to treat PD in either the acute or chronic phases due to the absence of any proven benefit [7]. Examples include vitamine E, tamoxifen, procarbazine, omega-3 fatty acids, and combination Vitamin E + L-carnitine. The European Association of Urology and International Society of Sexual Medicine guideline panels also recommend against potassium para-aminobenzoate, pentoxifylline, and colchicine, whereas the American Urological Association and Canadian Urological Association guidelines state that these agents have “unclear benefits” and may be considered.

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References

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  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Matthew Ziegelmann

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Ziegelmann, M. Is there a new role for oral therapy to treat peyronie’s disease? Commentary on Daily low-dose tadalafil may reduce the penile curvature progression rate in patients with acute Peyronie’s Disease: a retrospective comparative analysis. Int J Impot Res 36, 160–161 (2024). https://doi.org/10.1038/s41443-023-00684-7

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