Male Pattern Baldness [MPB] & PCa risk.

[pjoshea13]

New Canadian study below [1].

Lots of old studies. What's different about this one? Norwood:

"(0: no balding; 1: frontal balding; 2: mild vertex balding; 3: moderate vertex balding; 4: severe vertex balding)"

"Norwood patterns were increasingly associated with cancer and high-grade disease with a dose-effect ...

"On multivariable analyses, trends still held, with all patients exhibiting Norwood scale 3 and 4 at increased risk for cancer. ...

"In predicting risk of high-grade disease, only patients with Norwood pattern 4 exhibited an increased risk."

"MPB appears to be a strong and independent risk factor for both cancer and high-grade disease for men presenting for prostate biopsy."

...

MPB, aka "androgenetic alopecia" was associated with PCa in a number of studies. Almost all of them associated the risk with vertex balding & not frontal balding, but there is a study from Freedland that reported the reverse.

What isn't mentioned in any of these papers is whether it falls under the category of familial risk. My understanding is that a man's risk for premature balding comes from his mother. Does that kind of balding come with PCa risk?

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/280...

Can Urol Assoc J. 2016 Nov-Dec;10(11-12):E424-E427. doi: 10.5489/cuaj.3813. Epub 2016 Dec 12.

The association of male pattern baldness and risk of cancer and high-grade disease among men presenting for prostate biopsy.

Al Edwan G1, Bhindi B2, Margel D2, Chadwick K2, Finelli A2, Zlotta A3, Trachtenberg J2, Fleshner N2.

Author information

1Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada; University of Jordan, Amman, Jordan.

2Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada.

3Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.

Abstract

INTRODUCTION:

Androgens have been implicated in both male pattern baldness (MPB) and prostate cancer (PCa). We set out to prospectively determine if men with independently assessed MPB are at higher risk for PCa at biopsy and determine if any grade associations exist.

METHODS:

We prospectively enrolled 394 eligible patients presenting for prostate biopsy and independently determined their MPB pattern using the validated modified Norwood classification system (0: no balding; 1: frontal balding; 2: mild vertex balding; 3: moderate vertex balding; 4: sever vertex balding). Univariate and multivariable models, including Norwood score, age, prostate-specific antigen, and digital rectal examination abnormalities, were calculated for the outcomes of cancer and high-grade disease (Gleason >6). C-statistics analyses of our models were then compared with and without MPB pattern for marginal utility.

RESULTS:

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 and p=0.001 and p=0.0036 for high-grade disease on univariate and multivariable analyses, respectively). On multivariable analyses, trends still held, with all patients exhibiting Norwood scale 3 and 4 at increased risk for cancer. In predicting risk of high-grade disease, only patients with Norwood pattern 4 exhibited an increased risk.

CONCLUSIONS:

MPB appears to be a strong and independent risk factor for both cancer and high-grade disease for men presenting for prostate biopsy. Ours could be superior to marketed costly genetic tests. Further research is needed to understand the biology behind this observation and to incorporate these findings into clinical decision-making.

PMID: 28096933 DOI: 10.5489/cuaj.3813

[PubMed]

[Dan59]

Patrick, more good info! As I understand it male pattern baldness is associated with high Dihydrotestestosterone levels (DHT) which has often been thought to be the more dangerous form if testosterone for PCa, DHT levels are reduced with dutasteride/avodart

Dan

[pjoshea13 in reply to Dan59]

Dan,

Androgenetic alopecia is not associated with "high" DHT, but rather, "the genetically-determined sensitivity of the follicles to DHT" [1].

Androgenetic alopecia is also associated with the metabolic syndrome:

"There was a significant difference in number of patients with AGA manifesting criteria of metabolic syndrome (51% vs 28%), as well as BPH diagnostic criteria (36% vs 6.8%) compared with the control subjects." [2]

Here is an interesting paper:

"Big head? Bald head! Skull expansion: alternative model for the primary mechanism of AGA." [3]

Of course, DHT has become the target in AA treatments, just as androgens have for PCa, so it's natural, I suppose, to view DHT as the root cause (excuse pun)..

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/252...

[2] ncbi.nlm.nih.gov/pubmed/274...

[3] ncbi.nlm.nih.gov/pubmed/187...

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I am Norwood 0, age 66, diagnosed several months ago with Gleason 8. My psa was an unusually low 2.7.