Association between male pattern baldness and prostate disease: A meta-analysis

doi:10.1016/j.urolonc.2017.09.022

Urologic Oncology: Seminars and Original Investigations

Volume 36, Issue 2, February 2018, Pages 80.e7-80.e15

https://doi.org/10.1016/j.urolonc.2017.09.022 Get rights and content

Highlights

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17 studies comprising 68,448 participants were eligible for the meta-analysis.
•
Baldness is positively associated with aggressive PCa as well as BPH.
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There was statistically significant association between vertex baldness and PCa.
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No association between vertex, frontal plus vertex hair loss pattern and BPH.

Abstract

Background

Male pattern baldness (MPB) has been associated with an increased risk of prostate cancer (PC) as well as benign prostatic hyperplasia (BPH). We performed a meta-analysis to quantitatively determine the level of risk of PC and BPH in individuals with baldness.

Methods

A systematic literature search was conducted using several databases. We calculated pooled odds ratios (OR) and 95% CIs.

Results

In total, 17 studies comprising 68,448 participants were eligible for the meta-analysis and showed that MPB is associated with an increased risk of aggressive PC (OR = 1.59; 95% CI: 1.36–1.86; P<0.001) as well as BPH (OR = 1.26; 95% CI: 1.05–1.51; P = 0.01). There was statistically significant association between vertex baldness and PC (OR = 1.18; 95% CI: 1.05–1.32; P = 0.006). No statistically significant association between vertex, frontal plus vertex hair loss pattern, and BPH were identified.

Conclusions

MPB is associated with an increased risk of PC and BPH. Despite our findings, further studies, preferably prospective cohort studies, are required to better elucidate these relationships and to advance knowledge in this field.

Introduction

Male pattern baldness (MPB) is the most common cause of hair loss mediated by systemic androgens and genetic factors, which affects up to 70% of men and increases with age [1]. Androgens and the androgen receptor are required for expression of the male phenotype. However, MPB is an androgen-independent genetic disorder which is induced via the activation of androgen receptor in hair follicles by dihydrotestosterone. Inhibition of dihydrotestosterone production can suppress the progression of MPB which can explain the phenomenon that eunuchs do not develop baldness if castrated before the age of 25 [2]. Androgens have also been strongly implicated in the carcinogenesis of prostate cancer (PC) and the development and maintenance of benign prostatic hyperplasia (BPH) [3], [4]. In addition, previous studies identified that finasteride, a 5α-reductase inhibitor, is the main agents for MPB and BPH because of they respond to the inhibition of 5α-reductase. Therefore, MPB seems to share similarly pathologic mechanisms with PC and BPH for aging and androgen influence.

PC is one of the most commonly diagnosed cancers and one of the most common causes of cancer related death in developed countries. Although some risk factors have been established for PC, they collectively explain only a fraction of the disease occurrence. Therefore, additional research to improve our understanding of the etiology of PC is needed. Several studies have investigated the relationship between MPB and PC and have yielded inconsistent results [5], [6], [7], [8], [9]. Recently, a meta-analysis [10] reported vertex baldness (but not frontal baldness) to be associated with an increased risk of PC, however, it only included 7 studies in its analysis and did not consider the relationship between MPB and BPH. Therefore, the aim of this study is to conduct a comprehensive meta-analysis of existing studies to confirm the association of MPB with PC and BPH.

Section snippets

Methods

This study protocol was approved by the institutional review board at the West China School of Medicine before initiation and it did not need ethical standard statement.

Characteristics of studies

A Preferred Reporting Items of Systematic Reviews and meta-analyses (PRISMA) [12] flowchart of screening and selection results shown in Fig. 1. Using our prespecified search strategy, 203 extracts were retrieved and 7 additional citations were obtained through reference lists. From 210 studies initially identified, 25 were considered potentially suitable. After a full-text review, 17 studies [5], [6], [7], [8], [9], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24] with

Discussion

The main finding of our meta-analysis is that baldness is positively associated with an increased risk of aggressive PC as well as BPH, compared to those without baldness. Our study is the most comprehensive meta-analysis to date that examines the association between MPB and prostate disease with 68,448 participants. It is the first meta-analysis to examine the relationship between MPB and aggressive PC and BPH. In the literature, it has been one previous meta-analysis on the effect of

Conclusions

We found baldness is positively associated with an increased risk of aggressive PC as well as BPH, compared to those without baldness. Despite our findings, further studies, preferably prospective cohort studies, are required to better elucidate these relationships and to advance knowledge in this field. In particular, the pathological mechanisms underlying our findings are far from clear and studies that are able to enhance our understanding in this area would be valuable.

Acknowledgments

Tao Jin has received grant from the Scientific Research Projects of Sichuan Health Bureau (20140030), the Technology Support Plan of Sichuan Province (2014SZ0210), Sichuan Province Traditional Chinese Medicine Science and Technology (2016Q042). Tao Wu has received grant from Natural Science Foundation of Sichuan Provincial Department of Education (16ZB0227) and Scientific Research Foundation of Health and Family Planning Commission of Sichuan Province (17PJ155). The funders had no role in study

Authors’ contributions

T.J. and T.W. have made substantial contributions to design the study. T.J. and J.M.L. have screened papers and conducted the quality rating and meta-analysis. The statistical analyses were conducted by S.D., X.D., and Y.T. . T.J. and T.W. have been involved in drafting the manuscript. All authors read and approved the final article.

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Original articleAssociation between male pattern baldness and prostate disease: A meta-analysis

Highlights

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Characteristics of studies

Discussion

Conclusions

Acknowledgments

Authors’ contributions

Differentiation

Ann Oncol

Cancer Epidemiol

J Am Acad Dermatol

Urology

Urology

Public Health

Androgenetic alopecia: pathogenesis and potential for therapy

Expert Rev Mol Med

VA: R. Androgens and human hair growth

Clin Endocrinol

Sex steroid hormone metabolism in relation to risk of aggressive prostate cancer

Cancer Epidemiol Biomarkers Prev

Age-dependent associations between androgenetic alopecia and prostate cancer risk

Cancer Epidemiol Biomarkers Prev

Androgenetic alopecia at various ages and prostate cancer risk in an equal-access multiethnic case-control series of veterans

Cancer Causes Control

Original article
Association between male pattern baldness and prostate disease: A meta-analysis