Augmenting Intralesional Collagenase Treatment with Testosterone Therapy Provides Greater Self-Assessed Improvement in Penile Curvature due to Peyronie's Disease

Abstract

Introduction: Testosterone (T) deficiency has been reported to be associated with Peyronie's disease (PD). This study investigated response rates to intralesional injections of collagenase clostridium histolyticum (XiaflexÔ) (CCx) for penile curvature in men who simultaneously received T therapy (TTh) and in men who received CCx without TTh. Methods: Search of electronic records identified all men treated with CCx from 2013 to 2018, and whether they also received TTh during that time. Laboratory results for baseline serum T, free T, and luteinizing hormone were available for all men. Response to CCx was categorized as no change, mild change, substantial change, or complete resolution based on subjective reports by patients. Results: A total of 117 men received treatment with CCx. Of these, 72 received CCx alone (henceforth referred to as XA group) and 45 received CCx plus TTh (referred to as XT group). Mean baseline serum T was 458 ng/dL for the XA group and 384 ng/dL for the XT group (p = 0.10). Mean age was 60.4 years for the XT group and 56.5 years for the XA group (p = 0.028). Baseline mean curvature was 46°for the XA group and 45°for the XT group. Mean number of treatment cycles (two injections per cycle) was 2.7 for both groups. Overall, 67.5% reported some improvement in curve with CCx. Reports of any improvement were 84.4% for the XT group and 56.9% for the XA group (p < 0.001). Conversely, rates of no improvement were 15.6% for the XT group and 43.1% for the XA group. Substantial improvement or complete resolution of curve was noted by 48.8% of the XT group and 20.8% of the XA group (p = 0.001). Conclusions: These pilot observational results suggest that TTh may improve the response to intralesional CCx treatment of PD. A prospective study is warranted to investigate this further.

Peyronie's disease response to intralesional collagenase clostridium histolyticum therapy is independent of baseline testosterone

“…Mitsui et al 15 similarly evaluated 109 PD patients in Japan and found an inverse correlation between penile curvature and testosterone levels. 5 However, this correlation did not remain significant after adjusting for other factors. The study demonstrated that patients with severe curvature had lower mean tT levels than those with less severe curvature, but there was no significant difference between different testosterone groups or quartiles.…”

“…Mitsui et al 15 . similarly evaluated 109 PD patients in Japan and found an inverse correlation between penile curvature and testosterone levels 5 . However, this correlation did not remain significant after adjusting for other factors.…”

“…However, testosterone has additionally been proposed as an adjunct in treatment of PD, as it could act synergistically with CCh treatment by means of contributing to collagen degradation and reducing fibrosis or by stimulating anti‐fibrotic pathways itself independent of coadministration with other pharmaceuticals. Shlykova and Morgentaler 5 in 2020 showed a subjective improvement in PD symptoms after supplementation with testosterone during treatment with CCh; however, their investigation was limited by patient‐reported outcomes and a lack of objective improvement measures.…”

“…3,4 Interestingly, recent survey studies have suggested that CCh treatment outcomes are improved when given in conjunction with testosterone for PD. 5 Although there is room in the literature to suggest that testosterone can participate in anti-fibrotic signaling at the basicscience level, there is conflicting evidence in this regard, and the literature is not clear on testosterone's impact on PD treatment or severity. [6][7][8][9] Given this ambiguity in the literature, we sought to carry out an investigation to delineate the relationship between testosterone levels and the treatment of PD.…”