Low Vitamin D Predicts Aggressive Prostate Cancer

Lower serum vitamin D levels have been associated with an increased risk of aggressive prostate cancer and among men with localized prostate cancer, especially with low- or intermediate-risk disease; vitamin D may serve as an important biomarker of disease aggression.

Deficient vitamin D blood levels in men can predict aggressive prostate cancer identified at the time of surgery and this finding is important because it can offer guidance to men and their doctors who may be considering active surveillance, in which they monitor the cancer rather than remove the prostate.

A team of scientists led by those at Northwestern University (Chicago, IL, USA) assess the relationship between adverse pathology at the time of radical prostatectomy and serum 25-hydroxyvitamin D (25-OH D) levels. The team performed a cross-sectional study carried out from 2009 to 2014, nested within a large epidemiologic study of 1,760 healthy controls and men undergoing prostate cancer screening. In total, 190 men underwent radical prostatectomy in the cohort. Adverse pathology was defined as the presence of primary Gleason 4 or any Gleason 5 disease, or extraprostatic extension. The median age in the cohort was 64.0 years.

Of that group, 87 men had aggressive prostate cancer. Those with aggressive cancer had a median level of 22.7 ng/mL of vitamin D, significantly below the normal level of more than 30 ng/mL. The average vitamin D level in Chicago during the winter is about 25 ng/mL. On multivariate analysis, controlling for age, serum prostate specific antigen, and abnormal digital rectal examination, serum 25-OH D less than 30 ng/mL was associated with increased odds of adverse pathology (odds ratio = 2.64). The relationship between vitamin D and prostate cancer may explain some disparities seen in prostate cancer, especially among African American men. Prior studies have shown that African American men who live in low sunlight locations are up to 1.5 times more likely to have vitamin D deficiency than Caucasian men.

Adam B. Murphy, MD, an assistant professor of urology and corresponding author of the study, said, “Vitamin D deficiency may predict aggressive prostate cancer as a biomarker. Men with dark skin, low vitamin D intake or low sun exposure should be tested for vitamin D deficiency when they are diagnosed with an elevated prostate-specific antigen (PSA) or prostate cancer. Then a deficiency should be corrected with supplements.” The study was published on February 22, 2016, in the Journal of Clinical Oncology.

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