Background: Androgenetic alopecia, also known as male pattern baldness (MPB), is a common hair loss disorder among middle-aged men. MPB shares similar risk factors with prostate cancer (PrCa), including advancing age, family history, and sex hormones. Several studies have examined the associations between MPB and PrCa; however, the evidence remains unclear. We carried out an updated meta-analysis of epidemiological studies that examined the relationship between age at onset and patterns of MPB (either frontal, vertex, or both) and their associations with risks of total and aggressive PrCa. Methods: A literature search was performed using PubMed and Web of Science databases for epidemiological studies published between 1 January 2000 and 31 December 2024 that examined the associations between MPB and PrCa. From each eligible study, relevant data were extracted on study design and population, sample size, prevalence of MPB at various ages, and their association with PrCa. Pooled relative risks (RR) and corresponding 95% confidence intervals (CI) were calculated using the Der-Simonian and Laird random-effects models. Heterogeneity across studies was assessed by I2statistics, while the quality of studies was evaluated using the Newcastle–Ottawa Scale. Results: A total of 19 observational studies, including 17,810 cases and 146,806 controls/non-cases, were analyzed. The prevalence of MPB increased from 5% to 65% with aging and varied across the studies. Both frontal and vertex MPB were associated with a pooled RR of 1.08 (95% CI 1.02–1.14) for total PrCa, but there was no association with frontal-only MPB. Younger-onset MPB (<40 years old) was also associated with an RR = 1.13 (95% CI 0.96–1.31) for PrCa, although results were not statistically significant. Vertex-only MPB was associated with more aggressive PrCa (pooled RR = 1.14; 95% CI 1.02–1.25); however, there was substantial heterogeneity in the definition of aggressive PrCa across the studies. Conclusions: Men with both frontal and vertex MPB have a modestly elevated risk of PrCa. However, most studies were conducted in Caucasian men and they did not evaluate effect modifications by genetic variations in androgen metabolism pathway genes or changes in serum levels of androgens with aging. Large prospective cohort studies with more accurate longitudinal assessment of hair loss patterns are needed to better understand the complex relationship between genetic susceptibility, endogenous hormones, MPB, and subsequent risk of PrCa.
背景：雄激素性脱发，亦称男性型秃发，是一种常见于中年男性的脱发疾病。该疾病与前列腺癌具有相似的风险因素，包括年龄增长、家族史及性激素水平。多项研究已探讨男性型秃发与前列腺癌的关联，但证据仍不明确。本研究对流行病学文献进行更新的荟萃分析，重点考察男性型秃发发病年龄与脱发模式（前额型、头顶型或混合型）及其与总体前列腺癌和侵袭性前列腺癌风险的关系。 方法：通过PubMed和Web of Science数据库检索2000年1月1日至2024年12月31日期间发表的探讨男性型秃发与前列腺癌关联的流行病学研究。从符合条件的研究中提取研究设计、人群特征、样本量、不同年龄段的男性型秃发患病率及其与前列腺癌关联的相关数据。采用Der-Simonian和Laird随机效应模型计算汇总相对风险及其95%置信区间。通过I²统计量评估研究间异质性，并采用纽卡斯尔-渥太华量表评价研究质量。 结果：共纳入19项观察性研究，包含17,810例病例及146,806例对照/非病例。男性型秃发患病率随年龄增长从5%升至65%，各研究间存在差异。混合型（前额与头顶）脱发与总体前列腺癌的汇总相对风险为1.08（95% CI 1.02–1.14），但单纯前额型脱发未显示显著关联。早发型脱发（<40岁）与前列腺癌的相对风险为1.13（95% CI 0.96–1.31），但结果未达统计学显著性。单纯头顶型脱发与侵袭性前列腺癌风险升高相关（汇总RR=1.14；95% CI 1.02–1.25），但各研究对侵袭性前列腺癌的定义存在较大异质性。 结论：患有混合型男性型秃发的男性前列腺癌风险轻度升高。然而，现有研究多基于白种人群，且未评估雄激素代谢通路基因变异或随年龄增长的血清雄激素水平变化对关联的影响。未来需要通过大规模前瞻性队列研究，结合更精确的脱发模式纵向评估，以深入理解遗传易感性、内源性激素、男性型秃发与前列腺癌风险之间的复杂关系。
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