Early Baldness is Associated with Prostate Cancer Development

Abstract & Commentary

By William B. Ershler, MD

Synopsis: In a case-control study, patients with prostate cancer and matched controls were asked to recall whether they experienced male-pattern baldness by 20, 30, or 40 years of age. Prostate cancer patients were twice as likely to have alopecia at age 20 than controls. Early-age alopecia was not associated with early diagnosis of prostate cancer or with markers of disease aggressiveness. Thus, men with male-pattern baldness at age 20 may be at higher risk for the development of prostate cancer and perhaps more aggressive screening or other disease preventing interventions might prove beneficial for this population.

Source: Yassa M, et al. Male pattern baldness and the risk of prostate cancer. Ann Oncol 2011;22:1824-1827.

Intuitively, one might expect an increased incidence of cancer among men with alopecia. Androgens, critical to the pathogenesis and progression of prostatic cancer, also are known to play a role in the development of male-pattern baldness.1,2 Furthermore, finasteride, a type II 5-alpha reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone is used in the treatment of male-pattern baldness and has been shown to reduce the incidence of prostate cancer.3,4 Nonetheless, the demonstration of an association of baldness with prostate cancer has been inconclusive. Some studies examined baldness at the time of diagnosis, and these generally were negative.5,6 However, the onset of early-onset baldness might well be different. In one prospective study over approximately 20 years, men with male-pattern baldness had a 50% greater risk for developing prostate cancer.7 In still another study, men who developed baldness by age 30 had close to a two-fold increase in the risk of cancer.8 But in a more recent epidemiological study, Wright and colleagues found that subject recollection of baldness at the age of 30 was actually associated with reduced incidence of prostate cancer.9

In an effort to clarify this issue, Yassa and colleagues conducted a case-control study enrolling patients and matched controls, all of whom were asked to recall the presence or absence of hair loss at 20, 30, and 40 years of age. They were guided in their responses by pictures of various characteristic balding patterns.

The study revealed that patients with prostate cancer were twice as likely to have androgenic alopecia at age 20 (odds ratio [OR] 2.01, P = 0.0285). No specific pattern of hair loss was predictive for the development of cancer. There was no association between early-onset alopecia and an earlier diagnosis of prostate cancer or with the development of more aggressive tumors.

Commentary

This was a well-conducted retrospective case-control study that relied heavily on patients' recollection of the onset of hair loss. The mean age of both subjects and controls was greater than 65 years, and for some, the accuracy of assessing their own hair loss at ages more than 4 decades earlier might be tenuous. That stated, prostate cancer patients had twice the risk of having shown evidence for male-pattern baldness at age 20 than did controls. Baldness first recognized at age 30 or beyond was not significantly associated with developing prostate cancer.

These days there is increased interest in disease prevention, and thus establishing risk factors is of more than passing interest. The data, and that accumulated from prior studies, support the conclusion that early-age male-pattern baldness is associated with later in life prostate cancer. Perhaps, as the authors suggest, this population might benefit from routine prostate cancer screening or systematic use of 5-alpha reductase inhibitors as primary prevention strategies. Such might be the subject of a valuable, but long-term, interventional trial.

References

1. Sinclair R. Male pattern androgenetic alopecia. BMJ 1998;317:865-869.

2. Vierhapper H, et al. Production rates of dihydrotestosterone in healthy men and women and in men with male pattern baldness: Determination by stable isotope/dilution and mass spectrometry. J Clin Endocrinol Metabolism 2001;86:5762-5764.

3. Thompson IM, et al. The influence of finasteride on the development of prostate cancer. New Eng J Med 2003;349:215-224.

4. Vickers AJ, et al. Finasteride to prevent prostate cancer: Should all men or only a high-risk subgroup be treated? J Clin Oncol 2010;28:1112-1116.

5. Demark-Wahnefried W, et al. Serum androgens: Associations with prostate cancer risk and hair patterning. J Andrology 1997;18:495-500.

6. Hsieh CC, et al. Risk factors for prostate cancer: A case-control study in Greece. Int J Cancer 1999;80:699-703.

7. Hawk E, et al. Male pattern baldness and clinical prostate cancer in the epidemiologic follow-up of the first National Health and Nutrition Examination Survey. Cancer Epidemiol Biomarkers Prev 2000;9:523-527.

8. Giles GG, et al. Androgenetic alopecia and prostate cancer: Findings from an Australian case-control study. Cancer Epidemiol Biomarkers Prev 2002;11:549-553.

9. Wright JL, et al. Male pattern baldness and prostate cancer risk in a population-based case-control study. Cancer Epidemiol 2010;34:131-135.