Anogenital distance and the risk of prostate cancer

Study Type – Prognosis (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? In animals, anogenital distance has been shown to be related to the action of fetal androgens, and exposure to chemicals such as dioxins that exhibit antiandrogenic activity results in shorter distances in male rats. In studies conducted in children, anogenital distance has been associated with endocrine disruptors such as phthalates. Studies conducted in young adults found that a shorter anoscrotal distance was a predictor of low sperm concentration, and a longer anoscrotal distance was associated with fatherhood, a higher sperm density and a higher total motile sperm count. The present study is the first to report anogenital measurements in adults in relation to the risk of cancer, showing that a phenotype reflecting normal in utero sexual development in males is associated with a lower risk of prostate cancer. There are two published studies evaluating sperm quality and fatherhood suggesting a connecting mechanism related to the disruption of androgen-mediated pathways in utero that affects reproductive potential and the risk of prostate cancer. OBJECTIVES • To measure anogenital distance in patients with prostate cancer and control subjects without cancer. • To evaluate the association of anogenital distance with prostate cancer in a case–control study in Spain. MATERIALS AND METHODS • Anogenital distances from anus to upper penis (AGDAP) and from anus to scrotum (AGDAS) were measured in 60 patients with prostate cancer in two hospitals in Barcelona and in 52 urological controls. • Each measurement was performed three times by the same trained examiner using a digital caliper RESULTS • Patients had an ≈5 mm shorter AGDAP than controls, whereas no difference was observed for AGDAS. • A higher AGDAP was associated with a lower risk of prostate cancer, with an adjusted odds ratio per 5 mm increase in AGDAP of 0.83 (95% confidence interval, 0.70–0.99, P= 0.03). CONCLUSIONS • The present study is the first to report anogenital measurements in adults in relation to the risk of cancer. • The present study showed that a phenotype reflecting normal in utero sexual development in men is associated with a lower risk of prostate cancer. • There are two published studies (Mendiola et al. Environ Health Perspect 2011; 119: 958–63; Eisenberg et al. PLoS One 2011; 6: e18973) evaluating sperm quality and fatherhood suggesting a connecting mechanism related to the disruption of androgen-mediated pathways in utero that affects reproductive potential and the risk of prostate cancer.