It has been suspected for years that there was some form of connection between “male pattern baldness” and being at risk for prostate cancer, and past studies have tended to validate this, but arguably not as well as the one described below.
Because androgen levels in the blood have been clearly linked to risk for male pattern baldness and to risk for prostate cancer, Al Edwan et al. put together a prospective clinical study to see if they could prove an association based on grade of baldness and grade of cancer.
“Grade” of baldness is customarily now measured using what is known as the “modified Norwood classification system”, in which
- 0 = no balding
- 1 = frontal balding
- 2 = mild vertex balding
- 3 = moderate vertex balding
- 4 =severe vertex balding
Al Edwan et al. enrolled nearly 400 men into their study, in which patients presenting for prostate biopsy were also independently assessed for their Norwood score, and the results (along with PSA data, age, and DRE data) were used to assess any cross-association between presence of various grades of balding and presence of grades of cancer.
Here are the core results:
- 394 eligible patients were enrolled in the trial.
- Average (median) PSA for the entire cohort was 5.87 ng/ml (range, 4.3 to 8.51).
- Average (mean) age was 62.7 years.
- 108/394 patients (27.4 percent) had abnormal DREs.
- Average (median) prostate volume was 43 cm3.
- 58/394 patients (14.7 percent) had had a prior biopsy.
- 78/394 patients (19.8 percent) had a positive family history for prostate cancer.
- 194/394 men (49.2 percent) were diagnosed with prostate cancer.
- 110/394 men (27.9 percent) had Gleason 7 disease or higher at biopsy.
- Norwood patterns were increasingly associated with cancer and high-grade disease with a dose effect.
- p for trend < 0.001 on univariate and multivariable analyses for cancer
- p = 0.001 and p = 0.0036 for high-grade disease on univariate and multivariable analyses, respectively.
- In predicting risk of high-grade disease, only patients with Norwood pattern 4 exhibited an increased risk.
- There was no association between male pattern baldness and prostate volume.
The authors conclude that there
appears to be a strong and independent risk factor for both cancer and high-grade disease for men presenting for prostate biopsy.