COMMENTARY

Is Baldness an Indicator for Prostate Cancer?

Gerald Chodak, MD

Disclosures

March 03, 2011

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Hello, I'm Dr. Gerald Chodak for Medscape. This week, I want to talk about an article that appeared in the Annals of Oncology, written by Yassa and colleagues,[1] from France. They looked at whether there was a relationship between early-onset baldness in men and the development of prostate cancer. To find out, they conducted a case-controlled study using men who were followed in a radiation oncology clinic, and then they selected men of similar age at the same institution for the control group.

Their findings were, in some 680 patients, that men who developed baldness -- any form of it -- starting at age 20 were twice as likely to get a diagnosis of prostate cancer compared with men who did not have early-onset male baldness. The question is, how valid is this conclusion and what recommendations might be appropriate?

When we critique the study, a number of points are of major concern. First of all, we have no information about how men in the control group were monitored, screened, or tested for prostate cancer. We don't know whether the method of following these men was any different from that for the men who were actually diagnosed with prostate cancer. There is a very strong possibility of a selection bias in these 2 groups.

Another problem is that the [group of] men who were actually being followed included a higher proportion of men with high-grade disease (high PSA -- above 10 ng/mL, and high Gleason scores -- 7 or higher) than we would typically see in the general population.

Indeed, this was not a truly representative group of men with prostate cancer who were being diagnosed but a very selective group of men who had higher-grade, higher-stage disease. Whether the findings would apply across all stages of the disease in all grades is totally unclear. This concern in many ways invalidates the conclusions that might be made about this study.

Another concern is that the investigators didn't see any association between onset of baldness at age 30 or onset of baldness at age 40 and cancer incidence; the association was found only for the men with onset of baldness at age 20. In a retrospective analysis, the men reported on how much baldness they remember having, which would be appropriate if their survey instrument had been previously validated. However, at the end of the day, I do not believe that this study proves that men who experience onset of baldness at age 20 have a greater likelihood of developing prostate cancer.

To the credit of the investigators, they acknowledge that their findings do not shed light on whether strong recommendations for screening should be made in this younger age group, nor do they make any firm recommendations about whether these men should take 5-alpha reductase inhibitors.

However, one of the reasons why I'm commenting on this issue is that I saw a story on Fox News[2] that included the recommendation, without acknowledging any of the shortcomings or weaknesses of the study, that men who have early-onset baldness should indeed get more aggressive screening.

The bottom line here is that we have another study from a case-controlled analysis that doesn't prove anything. It suggests a relationship, but men who develop early-onset baldness should not be worried that they have a greater risk for the disease on the basis of this study. In looking at the literature, the information is very mixed because it is all derived from retrospective or uncontrolled trials. Whether early-onset baldness is a risk factor for prostate cancer remains unclear.

I look forward to your comments.

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