Some men voice complaints of shortened penis following prostate cancer treatment

A small percentage of men in a prostate cancer study complained that their penis seemed shorter following treatment, with some saying that it interfered with intimate relationships and caused them to regret the type of treatment they chose.

Complaints were more common in men treated with radical prostatectomy (surgical removal of the prostate) or male hormone-blocking drugs combined with radiation therapy, according to the study by researchers from Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC). No men reported a perceived shortening of their penis following radiation therapy alone.

The study's findings, which are being published in the January issue of the journal Urology, are based on surveys completed by physicians of 948 men treated for prostate cancer and who had suffered a recurrence of the disease.

Twenty-five men (2.63 percent of the group) complained of smaller penises after treatment – 3.73 percent for surgery, 2.67 percent for radiotherapy plus androgen deprivation therapy (ADT), and 0% for radiotherapy alone. Radiotherapy included both radiation administered by an external x-ray machine, and brachytherapy – the implantation of radioactive seeds directly into the prostate.

The scientific team, led by Paul Nguyen, MD, a radiation oncologist, and medical student Arti Parekh, said it is the first study to link men's perceptions of a reduction in penis size to lowered life satisfaction, problems in emotional relationships, and misgivings about the specific form of prostate cancer treatment they chose.

Nguyen said that the potential side effect of a smaller penis is well-known among physicians and surgeons, said Nguyen, "but it's almost never discussed with patients, so it can be very upsetting to some men when it occurs. Patients can deal with almost any side effect if they have some inkling ahead of time that they may happen."

The addition of short-term androgen-deprivation therapy to external-beam radiation therapy improved overall and disease-specific survival in men with nonbulky localized prostate cancer and prostate-specific antigen (PSA) levels up to 20 ng/mL, as reported recently in The New England Journal of Medicine. The benefit of the addition of short-term Christopher Jones, MDandrogen-deprivation therapy was seen mainly in men with intermediate-risk disease, not low-risk disease, in this large, randomized, phase III international trial.

A caveat about these findings is that the radiation techniques used in this study were those used in 1994, when the study was initiated. More sophisticated techniques now in use deliver higher doses than what was possible 17 years ago. The benefit of short-term androgen-deprivation therapy has not been proven with the newer techniques, said lead author Christopher Jones, MD, a radiation oncologist at Radiological Associates in Sacramento, California.

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