Baldness: Treatment Options and Possible Link to Prostate Cancer

Searching for a Link Between Baldness and Prostate Cancer

Interest in this unlikely duo arose recently when the U.S. Preventive Services Task Force (USPSTF) discouraged using prostate specific antigen (PSA) as a screen for prostate cancer in men with no symptoms of the disease.

USPSTF reviewed the evidence and concluded the test was unlikely to provide benefit, yet was associated with short- and long-term risks for side effects.

USPSTF is influential, and this recommendation is likely to severely restrict the use of a test that was the measure of cancer and prostate health for over 25 years.

Enter androgenic alopecia

Androgens are the potential link between baldness and prostate cancer, because of their role in the development of each condition.

Accordingly, researchers in the Netherlands sought to determine if the occurrence of androgenic alopecia (male pattern baldness) might help identify men at high risk of prostate cancer. Unfortunately, after comparing 938 prostate cancer cases to more than 2000 healthy men, they found no consistent association.

The bottom line

For those of us whose prostate cancer was detected at an early age — 49 years in my case — the USPSTF findings raises several issues. I've been cancer-free for more than 12 years. However, this was achieved at the cost of discomfort, pain, and subsequent surgery to correct the side effects of radiation therapy.

Considering the advances in treatment over the last 12 years, I'll never know for sure if waiting might have resulted in equal treatment success but less long-term discomfort.

Regardless, prostate cancer is mostly a distant memory, while my baldness expands every day. The next article reviews the most common treatment options for alopecia.

Treatment Options for Baldness
John Russo, Jr., PharmD

Androgenic alopecia (baldness) is responsible for more than 9 out of 10 cases of balding. In men, hair loss starts at the temples and is accompanied by thinning at the crown of the head. Areas of hair loss expand, affecting the front, top, and crown of the scalp. Hair loss in women is more diffuse. It occurs over the crown and frontal scalp, with retention of the hairline across the forehead.

Estimates of the prevalence of baldness vary, but everyone agrees it’s a common occurrence - even among women. Balding starts early - between 20 and 25 years of age — and increases in severity over time. Although neither life threatening nor painful, alopecia may have psychological consequences, including anxiety and depression.

No treatment completely reverses the balding process. However, relative success is most likely to be achieved when treatment is started early. Also, success is best when products with documented proof of regrowing hair are used. Here's a review of the most common treatment options.

Minoxidil

• Many products contain minoxidil, best known by the name "Rogaine®"
• Rogaine® is the only minoxidil-containing formulation with extensive documented success in studies of balding men and women
• Rogaine® is approved by the FDA to treat male and female pattern baldness
• The risk of adverse reactions to topically applied minoxidil is low.

5α-reductase inhibitors

• Many chemicals and botanicals inhibit the action of 5α-reductase to combine with testosterone and form dihydrotestosterone (DHT), which plays a role in alopecia
• Propecia® (finasteride) is an FDA-approved prescription drug to treat baldness in men but not women
• Avodart® (dutasteride) is similar to Propecia, but not FDA-approved to treat baldness
  • Avodart® has the potential to cause side effects such as feminizing of the male fetus, decreased libido, impotence, and decreased sperm count and motility
• Saw palmetto is not FDA-approved to treat anything, but is often added to alopecia treatments
  • Compared to Rogaine® and Propecia®, scientific evidence supporting saw palmetto is extremely limited
• All 5α-reductase inhibitors have the potential to mask PSA test results and delay diagnosis of prostate cancer and other conditions — use them only under a doctor’s supervision

Other treatments have limited or no evidence from studies of people with alopecia to support their use, although some promotional material is entertaining. Read the claims carefully, many of these products suggest they improve the quality of hair or stop hair loss, not regrow hair.