March 9, 2015 | by Sumanta Kumar Pal M.D.
My colleagues in the clinic know I’ve got a soft spot. Last week, a patient of mine offered me a fantastic compliment. “You’re looking younger these days, Dr. Pal!” she said, offering me a big hug as she proceeded out of the clinic room.
Lovely, I thought. The early morning workouts are paying off.
She continued: “Now if you’d just consider using some Rogaine, I think you’d set the dial back about 10 years!”
Ouch. My nurse gave me a somber look, understanding the pain these words had inflicted. I wouldn’t consider myself to be vain by any means, but my hair loss has created increasing conflict between me and my bathroom mirror. With every passing morning, I notice a little less hair up front, and a bit less up top. This pattern, termed frontal and vertex balding respectively, plagues nearly half of American males, albeit to different degrees. Until recently, the major toll of this hair loss for me has been cosmetic, chipping away at my self-image as a youthful oncologist.
A recent study published in the Journal of Clinical Oncology, however, suggests a more significant price. The study authors, based at several U.S. institutions, utilized a database of over 39,000 male patients who were involved in a trial to assess cancer screening. These men were asked to recall their pattern of hair loss at the age of 45, characterizing the degree of frontal and vertex balding.
The authors looked to determine the association between these features and prostate cancer risk. At first pass, there was no link between the simple presence of hair loss and prostate cancer. However, with a deeper look, the study authors were able to find a significant association between the combination of frontal with “moderate” vertex balding and aggressive prostate cancer. Compared to those patients with no balding, the risk of aggressive prostate cancer was nearly 40 percent higher in this group of men. Interestingly, the same association wasn’t found with “severe” vertex balding.
This is not the first study to tie baldness with prostate cancer, but it is the largest. In broad terms, these results are consistent with two previous studies, one based in the U.S. and another in Australia. So does baldness somehow cause prostate cancer? Although the current study cannot refute this, it’s somewhat unlikely. Rather, the same mechanisms that belie baldness (for instance, abnormal production of testosterone and other male hormones) may also drive the growth of prostate cancer in parallel. In fact, several genes have now been discovered that link the two processes.
Where might we go from here? My personal contention is that clinical characteristics such as the pattern of balding might ultimately influence whether to implement prostate cancer screening. Until recently, almost all men of a certain age were offered screening using a blood test for “prostate specific antigen” (PSA), a protein that can be elevated in the setting of prostate cancer.
For a variety of reasons, the pendulum has swung away from global PSA screening, and toward a more nuanced discussion with individual patients about the pros and cons of the approach. PSA screening might be more helpful in those patients with certain risk factors, such as a strong family history or African-American race. Although it will require further validation, the pattern of hair loss may ultimately add further fuel to this discussion.
Finally, if you’re left wondering what this data set has done to one paranoid 33-year old oncologist – I’ve got the Journal of Clinical Oncology's hair loss chart pasted to my bathroom mirror, and I’m driving my wife nuts by having her characterize my balding pattern daily.
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