What is the typical course of disease for a patient?

Course of Disease in Peyronie's Disease

Peyronie's disease follows a biphasic course with an active inflammatory phase lasting 3-12 months characterized by pain and evolving deformity, followed by a stable chronic phase where pain typically resolves but curvature persists, with disease stabilization occurring at 12-18 months after symptom onset. 1, 2

Active Phase (First 3-12 Months)

The active phase represents the initial inflammatory period with the following characteristics:

• Penile pain is the predominant symptom, occurring with or without erection 1, 2
• Dynamic symptoms that change over time, with incompletely developed plaques and deformities 2
• Pain resolution occurs naturally in many or most patients over time without intervention 1
• The active phase typically lasts 3-12 months from symptom onset 2

Natural History During Active Phase

• Younger men and those with symptoms present for less than six months may experience some spontaneous improvement in curvature 1
• Pain is highly susceptible to placebo effects, making treatment evaluation challenging 1
• The changing nature of symptoms during this phase makes it difficult to assess treatment efficacy 1

Stable Phase (After 12-18 Months)

Disease stabilization occurs when:

• Symptoms remain unchanged for at least 3 months 2
• Minimal or absent pain is present 2
• Established curvature with palpable or ultrasonographically visible plaques 2
• Disease typically stabilizes at 12-18 months after symptom onset 1, 2

Natural History During Stable Phase

• Curvature and deformity are less likely to resolve spontaneously compared to pain 1
• Treatment of persistent deformity may be required if it compromises sexual function and/or causes distress for the patient and/or partner 1
• The correlation between subjective patient perceptions and objective measures of deformity is limited 1

Typical Clinical Presentation

The most common presentation pattern includes:

• Male in his mid-50s with recent onset of penile curvature 1
• Mild to moderate penile pain accompanying the curvature 1
• No recalled specific event preceding symptom onset in most cases 1
• Erection remains firm enough for intercourse initially, though curvature may preclude or complicate intercourse 1
• No palpable abnormalities on the penile shaft in the non-erect state in many cases 1

Psychosocial Impact Throughout Disease Course

The psychological burden remains substantial and persistent:

• 54% of men report relationship difficulties as a result of Peyronie's disease 1, 2
• Depressive symptoms remain consistently high over time, suggesting lasting psychological impact 1, 2
• Men express concerns about physical appearance and report negative impacts on masculine self-image and sexual satisfaction 1
• Increased anxiety in sexual situations, decreased sexual confidence, and concern about partner satisfaction are common 1
• Sense of isolation develops as men find it difficult to communicate with healthcare professionals or partners about the condition 1

Critical Clinical Pitfall

The possibility of spontaneous improvement, particularly in pain symptoms, makes treatment effect assessment challenging in observational studies that cannot control for natural disease progression. 1 This underscores the importance of waiting for disease stabilization (at least 3 months of unchanged symptoms) before considering invasive interventions like surgery 2.