Table 3.
Drugs and Biologic Agents Used in Peyronie’s Disease Treatment
| Treatment | Proposed Mechanism of Action in PD | Recommended | Recommended AGAINST? |
|---|---|---|---|
| Systemic (Oral) | |||
| Procarbazine | Cytotoxic alkylating agent (?anti-inflammatory) | No | Yes |
| Vitamin E | Anti-oxidant (↓ROS) | No | No |
| Propionyl-L-carnitine | ↓Ca2+ in endothelial cells | No | No |
| Acetyl-L-carnitine | ↓Ca2+ in endothelial cells | No | No |
| Tamoxifen | Modulation of TGF-β1 secretion by fibroblasts | No | Yes |
| Omega-3 fatty acids | Anti-inflammatory | No | No |
| Pentoxifylline | Non-specific PDE-inhibitor → ↑NO, ↓TGF-β1 expression | No | No |
| L-arginine | Precursor of NO | No | No |
| Sildenafil | PDE5-inhibitor; may ↓collagen and ↑apoptosis index within plaque |
No | No |
| Colchicine | Anti-microtubule (anti-inflammatory) | No | Yes |
| POTABA | ↑ tissue O2 uptake, ↑GAG† secretion, ↑MAO‡ activity | No | Yes |
| Coenzyme Q1083 | Anti-oxidant (↓ROS), ↓TGF-β1 expression | No | No |
| Transdermal | |||
| Verapamil (EMDA or topical gel) | Ca2+ channel antagonist; may ↓collagen synthesis and/or ↑collagenase activity |
No | No |
| Dexamethasone (EMDA w/ verapamil) | Steroid (anti-inflammatory) | No | Yes |
| Liposomal recombinant human SOD* (topical) |
Antioxidant (↓ROS) | No | No |
| Intralesional | |||
| IFNα2a | ↓fibroblast proliferation → ↓collagen synthesis | No | No |
| IFNα2b | ↓fibroblast proliferation → ↓collagen synthesis | Yes | NA |
| Verapamil | Ca2+ channel antagonist; may ↓collagen synthesis and/or ↑collagenase activity |
Yes | NA |
| Collagenase Clostridium histolyticum | Clostridial collagenase | Yes | NA |
| Liposomal recombinant human SOD | Antioxidant (↓ROS) | No | Yes |
| Non-pharmacologic, non-surgical | |||
| ESWT | Direct damage to plaque and/or ↑vascularity 2/2 heat → plaque lysis159 |
Yes | NA |
| Penile traction therapy | Mechanical straightening and/or lengthening | No | No |
| Vacuum erection device therapy | Mechanical straightening and/or lengthening | No | No |
| Radiotherapy (RT) | Unknown | No | Yes |
| Hyperthermia therapy | Unknown (possible modulation of heat-shock proteins,160 ?↑vascularity 2/2 heat159) |
No | No |
| Surgical | |||
| Tunical albugineal plication | Tunical shortening (opposite side of plaque) | Yes | NA |
| Plaque incision/excision and grafting | Tunical lengthening (side of plaque) | Yes | NA |
| IPP (with possible penile modeling, tunical plication, or plaque incision/excision and grafting) |
Mechanical straightening (w/ or w/o plaque manipulation, tunical shortening or lengthening procedures) |
Yes | NA |
†
GAG: glycosaminoglycans
‡
MAO: monoamine oxidase
*
SOD: superoxide dismutase