Dr. Levine answers: This question addresses many issues in Peyronie’s disease, first that Peyronie’s disease can present with a variety of deformities anywhere along the shaft of the penis and there is nothing particularly unique with respect to treatment response about the curvatures which occur at the base, middle or distal shaft. There is also little evidence that spontaneous correction of a Peyronie’s disease plaque occurs. In fact, the most recent natural history studies show no more than 10% of men will have spontaneous improvement (not complete resolution) and that within the first 6 months to one year after the disease shows itself, 50% of men will get worse if no treatment is offered.
With regard to oral therapy, there is no published controlled trial of oral medications, which has been shown to provide any meaningful benefit with regard to penile deformity. Pentoxyphilline, and L-arginine, as well as the PDE5 inhibitors, have been shown in animal model studies to reduce the production of scar. Reports on these agents have not been published on humans. At this time these penile agents have not shown to reverse scarring other than occasional anecdotal reports.