Interview With Dr. Irwin Goldstein
Dr. Irwin Goldstein graduated from McGill University Faculty of Medicine in 1975. He was on the faculty of Boston University School of Medicine for 25 years where he was Professor of Urology and Gynecology.
Dr. Irwin Goldstein has been involved with sexual dysfunction research since the late 1970’s. He participated in the Xiaflex clinical trial and was one of the leading recruiters for the double blind placebo-controlled clinical research trial.
He is a 2009 winner of the Gold Medal awarded by the World Association for Sexual Health in recognition of his lifetime contributions to the field.
Dr. Irwin Goldstein is currently President of The Institute for Sexual Medicine, a charitable corporation for education and research in the field.
I'm honored that Dr. Goldstein agreed to be interviewed by My Peyronie's.
UPDATE June 2018 Dr. Goldstein is also the founder and medical director of San Diego Sexual Medicine.
Dr. Goldstein, please tell us a little bit about your background and your experience of treating patients with Peyronie's disease
I have been a sexual medicine MD – taking care of both men and women with sexual health concerns - since 1980. I have participated in the Xiaflex clinical trial and I was one of the leading recruiters for the double blind placebo-controlled clinical research trial.
I have performed several thousand intralesional injections of Peyronie’s plaques – primarily of Xiaflex and interferon – and strongly believe in medical versus surgical management.
Roughly, how many Peyronie's patients do you treat each year?
150 each year.
What is the average age of your Peyronie's patients?
I have seen young men – in the 20’s and older men – in the 80’s – and the average age is 40’s – 50’s.
How many of your patients fall approximately into each of the following groups: mild, moderate, and severe Peyronie's symptoms?
35%, 35%, 30% respectively.
How common do you think Peyronie's is? Do you think it is on the rise, e.g. due to lifestyle changes or environmental issues, or are men becoming more open about seeking assistance?
I actually studied a population of aging men in the Massachusetts Male Aging Study (MMAS) when I was in Boston and found that more than half of men have Peyronie’s plaques on physical examination – consistent with dorsal neurovascular bundle thickening. The study sponsors did not allow this to be published.
In your opinion, are some men more likely than others to develop Peyronie's disease?
Yes – there is definitive genetic predisposition.
How important is early diagnosis in your opinion? Can men expect better results the sooner they start treatment and why?
Not sure – but now that a safe and effective medical treatment is available – perhaps we can answer this question scientifically.
Can you describe the non-surgical treatments you recommend to your patients? What influences which treatments you recommend?
MONEY – either intralesional interferon with modeling (cheaper treatment) or intralesional Xiaflex with modeling (more expensive treatment). There are no other evidence – based safe and effective treatments available other than verapamil – but I have elected to use interferon.
What do you consider satisfying result from non-surgical Peyronie's treatment?
A patient that is less bothered and distressed - based on the treatment outcome.
What oral medication do you recommend to your patients and why?
NONE – there are no evidence – based safe and effective ORAL treatments available .
What is your view on using supplements as part of Peyronie's treatment plan?
NONE – there are no evidence – based safe and effective ORAL treatments available.
Have you used Xiaflex and / or Verapamil injections? If so, what is your experience of them? How does Xiaflex compare to Verapamil in your opinion?
EXCELLENT – for Xiaflex – I have not seen a patient fail – I have performed several thousand intralesion Xiaflex injections!!!
I have not used intralesional Verapmil – but have had excellent success with intralesional interferon.
Some clinical studies on injection therapies have shown improvements in patients in the placebo groups. This has led some to believe that injecting needle into the Peyronie's plaque may be beneficial on its own. What is your view on this?
We participated in this study – all the placebo patients in the initial double blind plabebo-contriolled study – the next year - received intralesional Xiaflex and all got a much better response.
Personally I do not believe that injecting a needle into a plaque on its own is helpful.
Have you recommended using traction device or penis pump to treat penis curvature? If so, what is your experience of them? When do you recommend using each device?
In my strong opinion, one has to combine an intralesional drug – either interferon or Xiaflex – with modeling by hand – to achieve the best results. I have some patients use the devices and the pumps – BUT – hand modeling in my opinion has been effectively tested in the Xiaflex trials.
What do you recommend for men that also suffer from low erection quality / erectile dysfunction?
PDE5 inhibitors, intracavernosal self-injection or if needed a penile implant.
Approximately how many (%) of your patients do not respond to non-surgical treatment and therefore require penis surgery? Have you been able to identify any common characteristics among those patients?
VERY VERY FEW – I am VERY impressed with GOOD effective intralesional injections. – Let me state not every MD is understanding on how to perform intralesional injections.
There MUST BE GREAT pressure on the palm of the injection hand and a pressure ring on the palm of the injection hand from the plunger – if one is to experience improvement from intralesional therapy.
What types of surgery do you perform and what is your experience of each?
Penile implant and modified Nesbit plication.
There is some risk involved with any surgery. In your experience, how common are serious side effects after penis surgery (e.g. erectile dysfunction, penile shortening, reduced penile sensation, loss of elasticity)?
Very few serious side effects – but – in my strongest, strongest opinion – the MOST UNHAPPY PATIENT IN UROLOGY - IS A POST-OP PEYRONIE’S PATIENT - WHO HAS SHORTENING OR NUMBNESS.
For patients that have undergone surgery to treat their Peyronie's disease, do you recommend some post operation treatment for them? If yes, what do you recommend?
What do you recommend that men with Peyronie's disease should do (or not do) to prevent the disease from getting worse?
Waiting until it is stable before having treatment.
How do you address the emotional side of Peyronie's? What can men do to deal with the distress caused by the disease?
We have an in-house sex therapist – all patients receiving any sexual medicine treatment is seen and evaluated prior and during treatment – this is a mandatory biopsychosocial approach.
In your opinion, how can partner or friend best support man with Peyronie's disease?
HUGE support can be realized by involving the partner.
What can be done to raise the awareness of Peyronie's, both among the public and health professionals?
EDUCATIONAL EFFORTS that are evidence – based.
What does the future hold for Peyronie's patients? Are there any interesting new treatments on the horizon (short term and long term)? Do you think Peyronie's will ever become curable?
We are re-assessing our Xiaflex Peyronie's patients – I cannot tell you of our results yet – but all that I have seen have been cured.
Anything you would like to add?
Dr. Irwin Goldstein, thank you very much for taking the time to do this interview with My Peyronie's. For more information about Dr. Goldstein, visit San Diego Sexual Medicine .