Treatment for prostate cancer can shorten the length of a man's penis
Men have complained their penises are smaller after surgery
Some treatments can damage nerves and tissues that cause erectionsThis may shorten the penis and lead to intimacy problems, say researchersProblem much more widespread than previously thought
15:50 GMT, 3 January 2013
18:16 GMT, 3 January 2013
A diagnosis of prostate cancer is devastating for any man, but new research suggests the problems may go on long after treatment.
Boston doctors say some men have complained their manhood is smaller after treatment, affecting their sex lives and causing them to regret the type of treatment they chose.
The research, published in the January issue of the journal Urology, found complaints were more common in men treated with radical prostatectomy (surgical removal of the prostate) or male hormone-blocking drugs combined with radiation therapy.
Some men have complained their manhood is smaller after treatment for prostate cancer, affecting their sex lives and causing them to regret the type of treatment they chose
But the researchers from Dana-Farber/Brigham and Women's Cancer Center in Boston found no men reported a perceived shortening of their penis following radiation therapy alone.
It's thought that some types of treatment, such as prostatectomy, can damage the nerves and tissues that cause an erection, so the penis is shortened.
The study's findings are based on surveys completed by doctors of 948 men treated for prostate cancer and who had suffered a recurrence of the disease.
Of the 948 men in the study, 22 per cent were younger than 60 and the majority were in their 60s, 70s and 80s.
Just over half – 54 per cent – had undergone surgery to remove their cancerous prostate, while 24 per cent received radiation therapy combined with hormone-blocking treatment, and 22 per cent had radiation therapy alone.
Twenty-five men (2.63 per cent of the group) complained of smaller penises after treatment – 3.73 per cent for surgery, 2.67 per cent for radiotherapy plus androgen deprivation therapy (ADT), and none for radiotherapy alone.
It's thought that some types of treatment, such as prostatectomy, can damage the nerves and tissues that cause an erection, so the penis is shortened
Radiotherapy included both radiation
administered by an external X-ray machine, and brachytherapy – the
implantation of radioactive seeds directly into the prostate.
surveys of the men did not report on their sexual functioning, but it
is well-known that prostate cancer treatment can raise the risk of
scientific team, led by Dr Paul Nguyen, 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.
Dr Nguyen said that the potential side-effect of a smaller penis is well-known among the medical community. 'But it's almost never discussed with patients, so it can be very upsetting to some men when it occurs,' he said.
'Patients can deal with almost any side effect if they have some inkling ahead of time that they may happen.'
The report's authors said doctors should discuss the possibility with their patients so that they can make more-informed treatment choices.
There were no direct measurements of penis size either before or after treatment, said the researchers. Nor did the patients' physicians specifically ask about this side effect; the issue was brought up by patients in conversations with their doctors.
For this and other reasons, the authors of the new study suggest that the problem is likely more common than reported in the survey.
'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,' added Dr Nguyen.
'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.'
The likelihood and magnitude of penis shortening as a consequence of treatment have not been well studied, said the researchers.
However, Jim Hu, a surgeon at the University of California, Los Angeles Medical Center and a co-author of the study, said previous studies had concluded there is shortened penis length following prostatectomy.
'This is most common with non-nerve sparing surgery, as this may result in fibrosis and atrophy of erectile tissue due to damage to nerve and vascular structures.'
Dr Kate Holmes, Head of Research at Prostate Cancer UK, said: 'Although this research appears to show that penis length can be affected by some treatment options for prostate cancer, there is already existing data to show this might be the case.
'Furthermore, it is hard to be certain of the accuracy of this data as the patients were asked if they thought the length of the penis had reduced.
'The research also looked at the effect of treatment on sexual relationships and sexual function. We know that treatment for prostate cancer can come with some distressing side effects. However, in this particular study, the patients all had reoccurring tumours, and therefore their emotional well-being might have affected how they responded, and therefore the results may not be reflective of all men with this disease.
'It is extremely important that men are given balanced information so that they are able to make the best treatment choice for them and given the emotional and psychological support to deal with side effects should they experience them.
'Any man who is concerned about the potential side effects of prostate cancer treatment should talk through their concerns with their doctor so that they make an informed choice about how to best treat their cancer while maintaining their quality of life.'
For more information: http://prostatecanceruk.org