Medical Meeting Reports

Peyronie’s Disease Session: SMSNA NYC November 2005

Insights from SMSNA's session on Peyronie's Disease:

New findings in the pathogenesis of Peyronie's disease

Authors: Evsey Mazo, Larisa Ivanchenko, Maati Moufagued

The cause of Peyronie's disease is unclear, even after 250 years of study. There have been many theories postulating the pathogenesis of PD, but no theory tells the whole story. Mazo and colleagues presented data looking at a possible viral cause for PD. He tested 41 patients with PD for markers of herpes simplex I, II and CMV (cytomegalovirus). He found that the markers for viral infection were elevated in PD patients. He suggested that all patients with PD be tested and treated for herpes and CMV while the Peyronie's is treated. While, the Mulhall group from Cornell Medical Center, has conducted an exhaustive assessment of viral particles in cells derived from Peyronie's disease tissue and failed to show that such exists, this remains an intriguing avenue of research that is probably not finished.

The pathogenesis of Peyronie's disease: A State of Altered Wound Healing

Authors: Ling De Young, Anthony Bella, BingSiang Gan and Gerald Brock; University of Western Ontario London, Ontario, Canada

De Young presented a study aimed at determining if altered protein expression exists in PD affected tunica albuginea (the external lining of the erection chamber affected by Peyronie's disease). He found that levels of proteins called a-actin, TGFb1/3, trans-glutaminase II, fibronectin, and HSP47 were increased in patients with PD as compared to controls (patients without PD). These changes in protein levels in the Peyronie's plaques may in the future help doctors identify those patients at risk for PD progression. Screening of men at risk for Peyronie's disease (those with a family history of the condition, history of penile trauma and those with diabetes, hypertension and cigarette smoking) remains a topic of great interest and it is hoped that we will be able to do in the future. How far off this is remains unknown at this time.

PARC siRNA translocates P53 to the nuclease and alters the biology of Peyronie's disease plaqu derived fibroblasts

Authors: John P. Mulhall, Jennifer Barnas, Keith Kobylarz; Weill Medical College of Cornell University & Memorial Sloan Kettering Cancer Center

Kobylarz from the Mulhall laboratory at Cornell Medical Center isolated Peyronie's disease cells from human penises. They then looked at a special protein called p53. p53 is important to the life cycle of the cell because it helps tell the cell when it is permitted to die. p53 is normally located in the nucleus of the cell. But this group has found that in PD cells, p53 gets anchored in the cytoplasm of the cell and binds with another protein PARC. This effectively renders p53 non-functional. The overall effect is that the Peyronie's disease plaque cells multiply instead of dying, which leads to progression of PD. These data may lead in the future to the development of a drug treatment to turn on p53 and thus permit the Peyronie's disease cells to die preventing scar build up.

Demographic characteristics and the prevelance of comorbid conditions in patients with Peyronie's disease

Authors: Hugo H. Davila, Jorge E. Garcia, Gregory Broderick and Rafael E. Carrion.; University of South Florida, Tampa, Fl.

Davila et al from the Florida reviewed the medical charts from 53 patients from the VA medical system. Their goal was to analyze the prevalence of medical conditions in that patient population. The authors concluded that PD was more common in Caucasians than in African Americans (73% vs. 6%) and non-Hispanic versus Hispanic patients (75% vs. 7%). The authors postulate the there is "a possibility of a multi-factorial, genetic process" involved. Davila additionally found that the most common medical conditions in men with PD were hypertension, erectile dysfunction, and musculoskeletal disease. To definitively answer the questions Davila et al are asking, studies would need to have thousands of patients in them. However, in clinical practice in most parts of the USA, Peyronie's disease is far more common ion whites compared to Blacks, Hispanics or Asians.

Diabetes Mellitus is a risk-factor for increased severity of Peyronie's disease: A comparative clinical study

Authors: Muammer Kendirci, Landon Trost, Suresh C. Sikka, Wayne J. G. Hellstrom; Tulane University, School of Medicine, Department of Urology, New Orleans, LA.

Kendirci from another major center studying Peyronie's disease, Tulane University in New Orleans presented data that examined the relationship of diabetes to PD. They specifically evaluated the severity of penile curvature in PD patients with and without diabetes. This comparative clinical study suggested that diabetes is the "only risk factor that increases the severity of PD compared to PD patients who have no other risk factors". This pilot study is of great interest as we have recognized that in young men with PD, diabetes is far more common than in the general population and may be a significant risk factor for the development of Peyronie's disease. Indeed, all men with Peyronie's disease under 40 years of age are screened for the presence of diabetes.

Ultrasound assessment of the penis in Peyronie's disease patients

Authors: Robert C. Dean, MD and Tom F. Lue, MD.; University of California, San Francisco Medical Center, San Francisco, CA.
 

The group led by Lue in San Francisco have been proponents of penile ultrasound for the assessment of PD severity. Lue and colleagues presented their data of 570 PD patients who underwent penile ultrasounds. 280 patients had abnormalities appearing on ultrasound. PD plaques were always associated with these abnormalities. 178 patients had calcification in the flaccid penis. The authors drive home the point that diagnostic ultrasound of the penis may be able to assess the maturity and severity of disease. This test can lead to "better treatment choices" for each patient. Most authorities assess penile deformity using penile injection to generate an erection and many combine this with a penile ultrasound to document plaque nature and size.

Correlation between intracavernosal injection, vacuum device and at-home photography

Authors: Michael Ohebshalom, Patricia Guhring, John P. Mulhall; Weill Medical College of Cornell University & Memorial Sloan Kettering Cancer Center, NY.

Mulhall and colleagues from Cornell Medical Center evaluated 3 different popular methods for measuring penile curvature: intracavernosal injection, vacuum erection device, and at-home photography. The authors concluded that intracaverosal injection was the optimal modality for the assessment of penile curvature. The degree of curvature was underestimated with the use of the vacuum erection device and at-home photography. The proper assessment of penile curvature in PD patients will lead to the best individual treatment choices for each patient.

Verapamil versuse saline in electromotive drug administration (EMDA) for Peyronie's disease: A double-blind placebo-controlled trial

Authors: Jason M. Greenfield, Sneja J. Shah, Laurence A. Levine; Rush University Medical Center, Chicago, IL.

From a treatment stand-point, Greenfield, from the Levine group in Chicago talked about an new way of delivering medication to the Peyronie's plaque. They studied the use of EMDA (electromotive drug administration) in PD. Essentially, medication (verapamil, saline, or others) is placed on the penile skin and a machine called a physionizer is used to create a tiny electrical current. This current painlessly drives the medication into the Peyronie's plaque. Levine's group studied this technique with both verapamil and saline in a double-blind, placebo controlled trial. Of the 23 patients who received verapamil, 65% had measured improvement, 22% had no change, and 13% worsened. In the placebo group similar result were found suggesting that the use of the machine alone may be a major factor rather the medication used.

Long-term treatment with Varndenafil reduces the development of the fibrotic plaque in a rat model of Peyronie's disease

Authors: Monica Ferrini, PhD, Istvan Kovanecz, PhD, Gaby Nolazco, MSc, Jacob Rajfer, MD and Nestor Gonzalez-Cadavid, PhD; University of California at Los Angeles, Los Angeles, CA.

Ferrini from UCLA, presented further modifications to the work that she has done centered around the use of PDE-5 inhibitors [sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis)] and the reduction of Peyronie's plaque development. This group administered vardenafil (Levitra) to rats with a PD-like plaque. They found that long-term administration of vardenafil slowed down and reversed the early stages of PD-like plaque development. This preliminary data are intriguing and will require confirmation with a large human study to answer this question.