The ‘PTNM’ system provides a new classification for Peyronie’s disease and penile curvature

Analysis of men seen in a specialist clinic provides new insights into the classification of Peyronie’s disease (PD) subtypes, according to a report in the September issue of the Journal of Urologyan Official Journal of the American Urological Association (AUA). The magazine is published in Wolters Kluwer’s Lippincott portfolio.

“By analyzing real-world clinical data in a large group of patients, we have identified four distinct subtypes of Parkinson’s, and additional categorization of other causes of penile curvature,” says Landon Trost, MD, of Male Fertility and Peyronie’s Clinic in Orem, Utah. . “We propose a new classification system, which we believe will provide a more consistent and standardized approach to the classification and treatment of Parkinson’s.”

Evidence-based approach to the classification of Peyronie’s disease

Peyronie’s disease is a condition in which the penis becomes curved due to scar-like tissue called plaque. Some men experience pain, erectile dysfunction or sexual dysfunction. Typically, PD is characterized by palpable plaque and curvature that occurs in men in their 50s and 60s (the Urology Care Foundation has a fact sheet on Peyronie’s disease).

But even in men with these ‘classic’ findings, symptoms of Parkinson’s disease can vary widely. Some men may develop a sudden curve, without other symptoms, that remains stable over time; while others may experience persistent pain and progression of the deformity. In the absence of more specific criteria, men with penile curvature, regardless of cause, are often diagnosed with Parkinson’s.

To identify patterns and clinical subtypes of Parkinson’s, Dr. Trost and colleagues clinical data from 1,098 men with confirmed penile deformity evaluated in the clinic from 2020 to 2023. In a second sample, secondary deformity or curvature was reported by 18 of 162 people who responded to a long-term follow-up survey.

The proposed system is a “remarkable advance” in the research and treatment of Parkinson’s

Statistical analysis of the data identified four distinct subtypes of PD: three “non-classical” subtypes defined by the presence of calcifications, progression (worsening curvature), or a relapsing/remitting pattern; and a “classic” subtype without these features. Men with classic Parkinson’s had some distinct characteristics, including older age, more stable curvature and fewer problems with pain.

Additionally, the researchers identified three non-PD categories: congenital (lifelong), adult (develops around puberty), and trauma-induced penile curvature. The progressive pattern was the most common finding and was observed in 57% of patients. Classical PD and trauma-induced non-PD penile curvature were both found in 27% of patients. (Some patients had overlapping subtypes, falling into multiple categories.)

Surprisingly, pain was not a reliable predictor of progression or stability of penile curvature. Analysis of the follow-up data suggested that the distinction between stable and progressive Parkinson’s can be made after three months of follow-up. A longer follow-up – at least six months – was needed to identify relapsing-remitting Parkinson’s.

Dr. Trost and colleagues propose a ‘PTNM’ classification system consisting of four factors: PD subtype, history of trauma, non-PD subtype, and stable or active mode during follow-up. This system “enables a more consistent and standardized method for classifying Parkinson’s and communicating among healthcare professionals.”

“Pending external validation, these findings represent a remarkable advance for the field of Parkinson’s,” the researchers added. They note that the patients in their study may not reflect the broader population of men with PD or non-PD penile curvature.

“We believe that our proposed PTNM system will be clinically useful in the evaluation and treatment of men with penile curvature,” says Dr. Proud. “This information has the potential to improve prognostic information, improve patient management and facilitate treatment decision-making in patients with Parkinson’s disease, and to guide further research.”