madman
Super Moderator
Susan MacDonald, MD, Associate Professor of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, reviews the pathophysiology of Peyronie’s disease and outlines research directions for the future. She explains that Peyronie’s disease typically affects men in midlife, with deformities ranging from plaques to ossified lesions, and often results in erectile dysfunction. Associations with diabetes, prostatectomy, and Dupuytren contracture suggest a systemic fibrotic or autoimmune process.
Dr. MacDonald challenges the current guideline-driven approach of waiting for plaque stabilization before intervention. She likens this to delaying cancer treatment until metastasis, arguing that such an approach misses the opportunity to intervene earlier. Histologic and molecular studies demonstrate that TGF-β signaling and SMAD pathways drive fibrosis and ossification. She notes parallels with heterotopic ossification and keloid formation, raising the possibility of genetic predisposition and autoimmune contributions.
She highlights research showing upregulation of fibrosis-related genes and identifies the need to study patients in the active phase of disease, when critical molecular events occur. Future work should include collaborative tissue banking, molecular assays, and exploration of genetic and epigenetic contributions. Dr. MacDonald stresses that progress will require moving beyond surgery to correct deformity after damage and toward preventive or early therapeutic strategies.
This talk underscores the importance of innovation in Peyronie’s disease research, encouraging multi-institutional collaboration and a focus on disease modification.
