Do we need to obtain consent for penile shortening as a complication of treatment for organ-confined prostate cancer?

What's known on the subject? and What does the study add? Penile shortening after total prostatectomy has been consistently reported, but most studies are small. BAUS has incorporated penile shortening into their patient information leaflets, but claims it is attributable to an anatomical alteration alone. No other organization even mentions penile shortening in their advice. Our study shows that a true, and at least partially reversible, penile shortening occurs in a significant proportion of patients after total prostatectomy. The cause of the shortening is largely physiological and interlinked with the processes leading to erectile dysfunction. OBJECTIVE • To establish an evidence base to guide consenting for treatment of organ-confined prostate cancer with regard to penile shortening. MATERIALS AND METHODS • We performed literature searches using the EMBASE, MEDLINE, AHMED and PsycINFO databases up to October 2011, looking for articles relating to surgical treatment of prostate cancer and penile shortening and articles relating to radiotherapy for prostate cancer and penile shortening. We also looked at further references in the papers identified. RESULTS • We found 16 original papers and three review articles with measurements of penile shortening after total prostatectomy (TP). • Penile shortening was generally considered in conjunction with erectile dysfunction (ED). • Three further articles address psychological and consent issues. • We found two articles regarding penile shortening after radiotherapy for prostate cancer. CONCLUSIONS • There is no doubt that TP leads to penile shortening in some patients, but the mechanism remains debatable. • Given current evidence, it is likely that several factors contribute and early penile rehabilitation for ED, by any method, appears to positively influence the changes leading to penile shortening. • We advise explicit mentioning of penile shortening in the consent process for TP and potentially also for radiotherapy for prostate cancer. We also advise early penile rehabilitation to improve the patient's own body image and, in turn, quality of life, even in patients who do not seek treatment specifically for ED. The choice of treatment method should be left to the patient.