Vitamin D Deficiency Predicts Prostate Biopsy Outcomes

Abstract

Purpose The association between vitamin D and prostate biopsy outcomes has not been evaluated. We examine serum vitamin D levels with prostate biopsy results in men with abnormal PSA and/or digital rectal examination. Experimental Design Serum 25-hydroxyvitamin D (25-OH D) was obtained from 667 men, age 40-79, prospectively enrolled from Chicago urology clinics undergoing first prostate biopsy. Logistic regression was used to evaluate the associations between 25-OH D status and incident prostate cancer (PCa), Gleason score, and tumor stage. Results Among European American (EA) men, there was an association of 25-OH D < 12 ng/ml with higher Gleason score ≥ 4+4 (OR = 3.66 [1.41, 9.50], p = 0.008) and tumor stage (stage ≥ cT2b vs. ≤ cT2a, OR = 2.42 [1.14, 5.10], p = 0.008). In African American (AA) men, we find increased odds of PCa diagnosis on biopsy with 25-OH D < 20 ng/ml (OR = 2.43 [1.20, 4.94], p = 0.01). AA men demonstrated an association between 25-OH D < 12ng/ml and Gleason ≥ 4+4 (OR = 4.89 [1.59, 15.07]; p = 0.006). There was an association with tumor stage ≥ cT2b vs. ≤ cT2a (OR: 4.22, [1.52 – 11.74], p = 0.003). Conclusions In AA men, vitamin D deficiency was associated with increased odds of PCa diagnosis on biopsy. In both EA and AA men, severe deficiency was positively associated with higher Gleason grade and tumor stage.

Null Association between Vitamin D and PSA Levels among Black Men in a Vitamin D Supplementation Trial

“…[13] Prior research has shown that vitamin D deficiency is an indicator of aggressive prostate cancer and spread of the disease in men who underwent their first prostate biopsy because of an abnormal PSA test. [14] Furthermore, a dose-response relationship between tumor grade and vitamin D levels was observed. [14] In a study of prostate cancer patients (Gleason 6 or 7), oral vitamin D3 (400, 10,000 or 40,000 IU/d) administered before prostatectomy, raised prostate calcitriol levels and lowered PSA.…”

“…[14] Furthermore, a dose-response relationship between tumor grade and vitamin D levels was observed. [14] In a study of prostate cancer patients (Gleason 6 or 7), oral vitamin D3 (400, 10,000 or 40,000 IU/d) administered before prostatectomy, raised prostate calcitriol levels and lowered PSA. [12] In a study of early stage low risk prostate cancer patients given vitamin D3 4000 IU/d for one year, a decrease in the number of positive cores at repeat biopsy was observed in more than half of the participants without a change in PSA.…”

Vitamin D and Cancer Risk and Mortality: State of the Science, Gaps, and Challenges

“…Studies to date on circulating vitamin D and prostate cancer risk in black men include retrospective, hospitalbased, case-control (120)(121)(122), and cross-sectional analyses (123,124). Among the prospective evaluations in black men, the number of cases has been relatively small (n = 91-250), contributing to imprecise risk estimates and inconsistent findings across studies (22,125,126) (Table 3).…”

Racial disparities in prostate cancer a molecular perspective

“…Significant evidence suggests that dietary habits such as consumption of alcohol, animal origin saturated fats, selenium, vitamin D, vitamin E, lycopene and isoflavones are also associated with prostate cancer racial disparities (9). Vitamin D insufficiency is a common public health problem in the United States and has been associated with prostate cancer mortality (10). AA men have low serum level of vitamin D than EA that might make them more susceptible to prostate cancer (11).…”