How to cite: MacDonald, Susan. “Peyronie’s Disease: Diagnosis, Treatment, & Future Directions.” October 2025. Accessed Mar 2026. https://grandroundsinurology.com/peyronies-disease-disease-process-and-future-directions/
Susan MacDonald, MD, Associate Professor of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, challenges conventional assumptions about Peyronie’s disease and outlines potential research directions to better understand and treat this complex condition. She reviews the clinical features of Peyronie’s disease, which is often associated with erectile dysfunction, diabetes, radical prostatectomy, and Dupuytren contracture. She explains that the disease has active and plateau phases, with plaque formation ranging from cartilage to bone and a broad spectrum of deformities.
Dr. MacDonald critiques current guideline recommendations that advise waiting until plaque formation stabilizes before treatment, comparing this to allowing cancer to progress before initiating therapy. Histologic studies reveal that transforming growth factor beta (TGF-β) and Smad signaling pathways drive fibrosis, collagen deposition, and ossification in Peyronie’s disease. She highlights similarities to heterotopic ossification and keloid formation, suggesting possible genetic or autoimmune contributions.
Emerging research includes genome-wide association studies identifying candidate genetic loci and expression studies highlighting potential therapeutic targets. She emphasizes that most research focuses on tissue from patients in the plateau phase, overlooking the critical molecular events of the active phase. She calls for multi-institutional efforts to collect and analyze tissue during the active phase, study both plaque and cavernosal tissue, and investigate genetic, epigenetic, and autoimmune associations.
Dr. MacDonald argues that advancing understanding of Peyronie’s disease requires collaborative research, tissue banking, and a shift toward earlier intervention strategies that target disease mechanisms rather than relying solely on surgery after damage is complete.
ABOUT THE AUTHOR
Susan MacDonald, MD, is an Associate Professor in the Department of Urology at Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania. Dr. MacDonald specializes in urethral reconstruction, prosthetic urology, graft and flap creation, and microsurgical dissection.
