Early Peyronie Research Articles

(375) Can Tamoxifen and a PDE5 inhibitor slow the progression of Peyronie’s Disease?

Abstract Introduction The available treatments for Peyronie’s Disease as recommended by international guidelines are either surgery or intralesional injection therapy. In recently cell and rat studies it has been shown that using a phosophdiesterase type 5 inhibitor (PDE5i) and a selective oestrogen receptor modulator (Tamoxifen) inhibited myofibroblast transformation and extracellular matrix production. Objective The aim of this study is to compare the combination of tamoxifen and a PDE5i versus no treatment or other oral medications in the progression of early Peyronie’s Disease. Methods This is a retrospective study of all patients with early Peyronie’s Disease, defined as less than 6 months duration or persistent pain presenting over a 3-year period. Patients were given Tamoxifen 20mg twice daily + Tadalafil 5mg daily for 2 months. The control group either received no treatment or simple oral medication such as Vitamin E. Data retrieved included demographics, duration of disease, change in curvature and pain, as well as further treatment modalities. Assessment of curvature was with photos or an artificial erection test. Data was analysed using the Mann-Whitney Test. Results A total of 147 patients were recruited with early Peyronie’s Disease, 102 patients given the active drug combination (median age 49, range 24-71) and 45 controls (median age 55, range 27-76). The results in each group are presented in Table 1. Overall, the patients on Tamoxifen and Tadalafil showed more improvement and less deterioration which was statistically significant (p=0.009) Conclusions The combination of Tamoxifen and Tadalafil has been shown to prevent the progression of Peyronie’s Disease in vitro and in this study in patients with early disease. Future prospective studies are warranted to confirm this finding. Disclosure No

Local lnterferon-Alpha2b Is Not an Effective Treatment in Early-Stage Peyronie's Disease

Peyronie's disease is characterized by an acquired penile deviation that may lead to severe penile deformity. It is refractory to most conservative therapy, and surgical correction is therefore the treatment of choice once the disease process has come to a halt. Basic science, as well as our first clinical results on the use of interferons (IFNs), have been promising, suggesting a beneficial effect in the early noncalcified disease stage. From July 1994 to October 1995, 30 patients suffering from early Peyronie's disease were treated with three local injections of 3 million units of IFN-alpha 2b each into the plaque(s). The interval between the injections was 1 week. Patients were assessed clinically and ultrasonographically 6 months after the last injection. Peyronie's disease clinically improved in only 1 case, remained stable in 26 patients and worsened in 3. In 7 patients, a total of 10 plaques at different sites were detected. By ultrasonography the treated plaques now showed calcifications in 3 cases, remained unchanged in 26 and could not be detected in 1 case. Of the 10 new plaques, 2 showed calcifications. Side effects (myalgia, fever) were considerable; in 74 of 90 injections, fever > 38 degrees C occurred, and a total of 8 working days were lost. IFN-alpha 2b, given according to our regimen, is not useful for the treatment of Peyronie's disease in the early stage since the disease progress continues at different sites in about 25% of the patients, and the side effects are untolerable. Our results also demonstrate that local therapy is not indicated in Peyronie's disease.

The Immunological Features of Peyronie's Disease

Purpose We investigated the immunological features and possible autoimmune basis of Peyronie's disease. Materials and Methods The sera of 100 patients with Peyronie's disease were tested for circulating autoantibodies, including anti-penis antibodies, by indirect immunofluorescence. Antibody deposition and the immunological activity in Peyronie's plaque tissue from patients with early and long-standing disease were also assessed. Results Circulating anti-penis antibodies were not found in any patient although antinuclear antibodies were present in 24 percent. Patients with early Peyronie's disease had IgM antibody deposition, marked T lymphocytic and macrocytic infiltration in the sub-tunical space, increased expression of adhesion molecules by endothelial cells and an increased human lymphocyte antigen class 2 expression by the cellular infiltrate, indicating cellular immune activation. Conclusions These results show that some of the features of autoimmunity, in particular the cell mediated response, are present in Peyronie's disease.