Radiotherapy for the Treatment of Peyronie Disease (Induratio Penis Plastica): An American Radium Society (ARS) Appropriate Use Criteria (AUC).

OBJECTIVES: To critically analyze the current evidence for the use of radiotherapy in the treatment of Peyronie Disease (PD). METHODS: A systematic review of the literature was designed using the Population, Intervention, Comparator, Outcome, Timing and Study Design (PICOTS) framework and was assessed using Cochrane and PRISMA methodology. Eligible studies included prospective and retrospective studies published between January 1, 1970 and June 24, 2026. Clinical variant cases were developed as examples to illustrate practical applications of consensus recommendations. RAND-UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. RESULTS: Evidence to support the use of radiotherapy treatment of PD is limited by poor quality evidence, which is based on older studies, heterogenous patient cohorts, inconsistent radiation dose fractionation schedules, and lack of objective measurable outcomes and long-term follow-up. Data suggests that radiotherapy may result in faster resolution of pain for patients with acute-phase PD; however, this observation does not take into account the possibility that any improvement may be due to the natural disease course as some patients experience spontaneous symptom resolution. Radiotherapy is not useful in the treatment of erectile dysfunction or penile deformity or in chronic-phase PD. CONCLUSIONS: Current literature contains insufficient evidence to recommend the routine use of RT for the treatment of PD. RT for treatment of PD should not be considered outside of a clinical trial.