Heightened risk for prostate cancer among balding males (redux)

Back in 2014, Zhou et al. reported an association between baldness and risk for diagnosis with aggressive forms of prostate cancer. At the time we noted that this association really needed to be confirmed in other studies.

In a newly published study in the American Journal of Epidemiology, Zhou et al. have now reported an association between baldness and risk for prostate cancer-specific mortality, based on a re-analysis of data from the first National Health and Nutrition Examination Survey (NHANES-I) Epidemiologic Follow-up Study.

Zhou et al. identified 4,316 men who were between 25 and 74 years of age at the time of the baseline NHANES-I surgery and who had no prior diagnosis of cancer. Then, using male pattern baldness as a proxy for long-term androgen exposure, they set out to investigate the association of dermatologist-assessed hair loss with prostate cancer-specific mortality in this group of men.

Here is what they report:

  • Average (median) follow-up was 21 years.
  • During this follow-up period there were
    • 3,284 deaths altogether (i.e.,  76.1 percent of the cohort died of all causes)
    • 107 deaths from prostate cancer (i.e., 3.3 percent of the deaths were prostate cancer-specific)
  • Comparing men with balding to men with no balding (and using a multivariable  analytic model)
    • Any degree of baldness was associated with a 56 percent increase in relative risk for fatal prostate cancer (hazard ratio [HR] = 1.56).
    • Moderate balding was associated with an 83 percent increase in relative risk for fatal prostate cancer risk (HR = 1.83)
    • Patterned hair loss was not statistically significantly associated with all-cause mortality.

The authors conclude that, based on their analysis:

patterned hair loss is associated with a higher risk of fatal prostate cancer and supports the hypothesis of overlapping pathophysiological mechanisms.

In other words, men with male pattern baldness are not only at higher risk for a diagnosis with aggressive prostate cancer; they are also at higher risk for prostate cancer-specific mortality.

Now one does have to be careful interpreting data like these. They are hypothesis-generating as opposed to “absolute” outcomes data. Actually proving an association like this would be extremely difficult. One also needs to realize that because these are relative increases in risk as opposed to absolute increases, the absolute risk that a balding male might die of prostate cancer is perhaps something like 4.0 percent (as opposed to 3.3 percent for all the men in the study).

5 Responses

  1. I can offer some support for this. I have been “afflicted” with male pattern baldness for many decades. In 2004, I was diagnosed with Gleason 9 prostate cancer. Fortunately it was caught early, before any metastasis, by the PSA test. I was treated with IMRT radiation + ADT and I’m still around to write this note.

    Manny R.

  2. Bring on the finasteride! …

  3. I have absolutely no balding at 50 and no male in my family does … yet at 42 I had prostate cancer … (3 + 3) but none the less prostate cancer. … I had a PSA of 2.4 at 38 years old. … Again no balding in my family. … Probably got it due to a full moon one night. These studies are a joke.

  4. Dear Chris:

    Actually these studies are not a joke. But the fact that you have no balding personally and there is none in your family does not mean that you are at no risk for prostate cancer.

  5. DHT as the Mechanism of Action

    DHT promotes baldness and also fuels prostate cancer.

    As Natron indicated, the 5-alpha-reductase inhibitor drugs Proscar/finasteride and Avodart/dutasteride sharply reduce the conversion of testosterone into DHT.

    While hardly conclusive, the study is possible evidence of this mechanism of action.

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