Intelligent Questions to Ask Your Doctor Winter 2015
Research has recently linked male pattern baldness at age 45 to an increased risk of aggressive prostate cancer.
Q: My hairline is definitely receding. Should I begin prostate screenings earlier and schedule them more often than is typically recommended?
A: The established factors for a higher risk of prostate cancer are African-American ethnicity and a close male relative with prostate cancer (such as a father, uncle, or brother). In addition, some guidelines for prostate screening would advocate a baseline prostate-specific antigen (PSA) test and digital rectal exam at age 45. If the exam is normal and the PSA is less than 1.0, then a patient’s risk is low and he can be screened again two to five years later. If the PSA is greater than 1.0, consider screening yearly for high risk; a common threshold for a prostate biopsy would be 2.5 or so. Any abnormal prostate exam should trigger biopsy consideration, even with a low PSA.
The baldness association paper was published in a very highly cited journal and will likely encourage more definitive research on the topic. The source of patients for this study, however, is very controversial: These men were heavily prescreened before entry into the study and the baldness categories were completed by memory of the patient. Thus, it is not a definitive study that would change clinical practice; men with and without baldness should think about prostate cancer screening at age 45, and discuss the pros and cons with their primary physicians.
Regarding prevention, the best advice is to incorporate a low-fat diet (similar to cardiac diet recommendations) and regular exercise. It is often quoted that men are most likely to die of cardiac disease, and that includes men with prostate cancer. It is fortunate and convenient that virtually all cardiac disease prevention methods also help mitigate prostate cancer risk.
—John W. Davis, MD, associate professor in urology, The University of Texas MD Anderson Cancer Center
(Continues on next page...)