According to a new study published online ahead of print in the Journal of Clinical Oncology, frontal plus moderate vertex baldness in 45-year-old men is linked with an elevated risk of developing aggressive prostate cancer.

In the study, researchers analyzed data from 39,070 men aged 55 to 74 who participated in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial from 1993 to 2001.

In order to be included, patients had to have no prior cancer diagnoses, excluding non-melanoma skin cancer, and be able to recall their hair-loss patterns at age 45 using a modified Norwood-Hamilton scale. The scale uses pictures of 5 types of baldness patterns and participants choose the type they had at age 45; the researchers note, however, that the validity and reliability of this scale have not been verified.1

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The researchers identified 1,138 cases of prostate cancer, 571 of which were aggressive, during a median follow-up of 2.78 years.

Patients with frontal plus moderate vertex baldness at age 45 was not significantly linked with overall prostate cancer risk (hazard ratio [HR], 1.19; 95% CI, 0.98-1.45) or nonaggressive prostate cancer risk (HR, 0.97; 95% CI, 0.72-1.30) compared with men with no baldness. By contrast, the same type of baldness was significantly associated with a 40% increased risk for developing aggressive prostate cancer (HR, 1.39; 95% CI, 1.07-1.80).

Other types of baldness were not associated with an increased risk of prostate cancer. The association between male pattern baldness and aggressive prostate cancer found in this study also support the theory that the two have related pathogeneses, including aging, hereditability, and endogenous hormones like dihydrotestosterone.1

Based on the results of this study, clinicians can identify patients with frontal plus moderate vertex baldness that may be at an increased risk for developing aggressive prostate cancer. Clinicians can advise these patients to reduce other risk factors that may be associated with increased risk for developing aggressive prostate cancer, such as obesity, smoking, and low amounts of physical activity.

Furthermore, clinicians can recommend that patients avoid saturated fat from meat and whole dairy sources and increase consumption of fish, nuts and seeds, soy, tomatoes, vegetables, and whole grains.2

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By being aware of the increased risk of aggressive prostate cancer in these particular men, clinicians can also make better decisions regarding treatment options if that patient is diagnosed with prostate cancer.

Rather than choosing watchful waiting or active surveillance, clinicians and patients may opt for radiation therapy (RT) in combination with androgen deprivation therapy (ADT) or RT plus brachytherapy with or without ADT as initial therapy if diagnosed. ADT can include surgical castration, treatment with luteinizing hormone-releasing (LHRH) analogs, LHRH antagonists, and/or anti-androgens.3

Ultimately, by observing a frontal plus moderate vertex baldness pattern in men aged 45, clinicians can better understand a patient’s risk for developing an aggressive form of prostate cancer and formulate more informed recommendations regarding risk factor reduction and treatment options if the patient is eventually diagnosed with the disease later in life.


  1. Zhou CK, Pfeiffer RM, Cleary SD, et al. Relationship between male pattern baldness and the risk of aggressive prostate cancer: an analysis of the prostate, lung, colorectal, and ovarian cancer screening trial. J Clin Oncol. 2014 Sep 15. [Epub ahead of print] doi: 10.1200/JCO.2014.55.4279.
  2. Prostate cancer risk factors. Harv Mens Health Watch. 2004;8(7):1-3.
  3. NCCN Clinical Practice Guidelines in Oncology™. Prostate Cancer. v 2.2014. Available at: Accessed September 27, 2014.