Novel classification system proposed for Peyronie disease, penile curvature

Experts have developed a novel classification system (PTNM) to characterize subtypes of Peyronie disease (PD) and non-PD penile curvature.^1,2

The investigators also identified 3 non-PD categorizations: congenital, maturational, and trauma induced.

The report was published in the Journal of Urology.¹

"By analyzing real-world clinical data in a large group of patients, we identified 4 distinct subtypes of PD, and additional categorization of other causes of penile curvature," said lead author Landon Trost, MD, of the Male Fertility and Peyronie's Clinic in Orem, Utah, in a news release on the study.² "We propose a new classification system, which we believe will provide a more consistent and standardized approach to classification and treatment of PD."

In their analysis, the investigators characterized 4 subtypes of PD, comprised of 3 “non-classical” subtypes and 1 “classical” subtype. The 3 non-classical subtypes are defined by the presence of calcifications (moderate or severe), progression (subjective worsening following disease onset), or a relapsing/remitting pattern (reactivation following ≥ 6 months of stability). The classical subtypes do not include any of these features, but do include some characteristics such as older age, more stable disease, and a reduced likelihood for pain or length loss.

The authors classified progressive disease as beginning at 3 months following disease onset. Relapsing/remitting classification requires a period of 6 months or more of stability before de novo disease or disease reactivation.

The investigators also identified 3 non-PD categorizations: congenital (lifelong), maturational (developed around puberty), and trauma induced.

Stable PD was then defined variably by disease subset, ranging from 3 or more months (classical subtype) to either 12 or more months plus 3 or more months of stability or 6 or more months of stability (other subtypes).

Thus, the proposed “PTNM” staging system comprises 4 steps, broken down as P = PD component (classical, calcifying, progressive, relapsing/remitting, or undifferentiated), T = trauma component (0, absent; 1, present), N = non-PD component (congenital, maturational, or undifferentiated), and M = mode (0, stable; 1, active).

In total, the retrospective study included 1098 men who initially presented with penile deformity to a single clinic from January 2020 to August 2023. The investigators also included 719 men who were previously evaluated for PD and were sent a follow-up at a median of 8.4 years following diagnosis for assessment of the relapsing/remitting subtype. Of these, 18 men reported a secondary curvature/deformity following stabilization of their primary disease and were included for analysis.

Among all patients included in the study, 27% of patients had the classical subtype, 14% had the calcifying subtype, 57% had the progressive subtype, 12% had the relapsing/remitting subtype, 7% had the congenital/maturational subtype, and 27% had the trauma induced subtype.

The authors note that external validation of the PTNM classification system is warranted.

Trost concluded in the news release, "We believe our proposed PTNM system will be clinically helpful in the evaluation and management of men with penile curvature. This information has the potential to improve prognostic information, enhance patient counseling, and facilitate treatment decision-making for patients with PD, as well as guiding further research."²

References

1. Trost L, Mulhall J, Hellstrom W. Creation of a novel classification system (PTNM) for Peyronie’s Disease and penile curvature using evidence-based criteria. J Urol. 2024;212(3):470-482. doi:10.1097/JU.0000000000004072

2.'PTNM' System provides new classification for Peyronie's disease and penile curvature. News release. Wolters Kluwer Health: Lippincott. Published online and accessed August 9, 2024. https://www.newswise.com/articles/ptnm-system-provides-new-classification-for-peyronie-s-disease-and-penile-curvature