Are low serum levels of vitamin D a risk factor for aggressive forms of prostate cancer?

It has long between understood that there is an association between a man’s serum levels of vitamin D and his risk for prostate cancer in general and clinically significant prostate cancer in particular. The nature of this association is complex, however, and taking vitamin D supplements to prevent risk for prostate cancer or as a treatment for prostate cancer is not necessarily a good idea for all men (or all prostate cancer patients).

A new study by Nyame et al. in the Journal of Clinical Oncology has now suggested, more explicitly, that men with serum levels of 25-hydroxyvitamin D < 30 ng/ml appear to be at a significant increase in risk for adverse pathology (i.e., a primary Gleason grade of 4 or 5 or extraprostatic extension of the cancer) after undergoing radical prostatectomy.

The data presented by Nyame et al. come from a large cohort of men, including 1,760 men undergoing prostate cancer screening and other  healthy controls. Of these 1,760 men, 190 (10.8 percent) were diagnosed with prostate cancer and went on to have initial treatment by radical prostatectomy.

Based on the data from these 190 men, Nyame et al. report that:

  • The average (median) age of the patients was 64 years.
  • 87/190 patients (45.8 percent) had adverse pathology after their surgery.
  • On univariate analysis,
    • Patients with adverse pathology at radical prostatectomy had a median serum vitamin D level of 22.7 ng/ml.
    • Patients with no adverse pathology at radical prostatectomy had a median serum vitamin D level of 27.0 ng/mL
    • This difference was statistically significant (P = 0.007).
  • On multivariate analysis (controlling for age, PSA level, and abnormal DRE)
    • Patients with a serum vitamin D level < 30 ng/ml had a significantly increased risk for adverse pathology (odds ratio [OR] = 2.64; P = 0.01).

The authors conclude only that:

Insufficiency/deficiency of vitamin D is associated with increased odds of adverse pathology in men with localized disease undergoing radical prostatectomy

and that serum levels of 25-hydroxyvitamin D

may serve as a useful biomarker in prostate cancer aggressiveness, which deserves continued study.

It would be interesting to see if such results could be replicated in much larger cohorts of men for whom pre-surgical blood samples are still available; diagnostic and post-surgical data are available; and long-term outcomes may also be established.

What these data do not tell us is whether vitamin D supplements given to men diagnosed with prostate cancer who have low vitamin D levels at time of diagnosis can improve the long-term outcomes of these patients. We also need to be aware that if men with low vitamin D levels have an increased risk for adverse pathology at surgery, then they have an increased risk for adverse pathology regardless of their treatment type. This may be something that needs to be considered as part of the work-up of all prostate cancer patients in order to ensure appropriately aggressive treatment.

6 Responses

  1. Thank you for bringing a note of sanity into the discussion of vitamin D. I hear from patients who are supplementing on their own, often taking large doses of this steroidal hormone, just because it is cheap and readily available. Very high serum levels of vitamin D have also been associated with prostate cancer.

    The biochemistry of vitamin D is very complex; as with most physiologic steroids there is negative feedback, escort proteins, enzymes that degrade it and aid in elimination, and multiple vitamin D receptors on all our cells. There are also defective receptors. It may be, for example, that Nyame et al. detected lower serum levels because of excessive vitamin D metabolism in men with prostate cancer, or the cancer may have high numbers of vitamin D receptors that are feeding on it. If that’s the case, supplementing may do harm rather than good.

  2. I have to agree that there is a strong connection between vitamin D and several types of cancer, especially prostate, breast, melanoma, and colon.

    My husband had very low vitamin D, 11 to be exact, and a very high PSA. All his other blood work was good. He had Gleason 9 of the prostate and lymph nodes when he was diagnosed. At that time I started reading medical studies from over 10 years ago with findings that low vitamin D and an elevated PSA indicate a more aggressive form of prostate cancer. At present his vitamin D runs in the 60s to 80s and his prostate cancer is in remission.

    I’m not saying vitamin D supplementation is a cure for prostate, but it may be a piece missing from the complex puzzle. I do realize that there could be more harm done by supplementation with poor quality products or without blood level monitoring. Vitamin D3 is more of a hormone than a vitamin and needs to be given in dosages per body weight and blood levels.

    On a related note, a good friend of mine who has breast cancer and goes to a major cancer center has her vitamin D3 supplemented as this center feels there is a strong correlation between vitamin D3 and breast cancer.

  3. The general consensus is that normal levels of vitamin D should range between about 90 and 100 nmol/l (equivalent to 35 to 40 ng/ml) for preventive health.

  4. Conversely to Alan’s remark that “Very high serum levels of vitamin D have also been associated with prostate cancer” is that low levels of vitamin D are certainly associated with adverse issues in men with prostate cancer. Just a check of the internet provides ample papers that reasonable levels of 25-hydroxyvitamin D are important to not only prostate cancer but other cancers and overall general health as well. A supposed “normal of 35 to 40 ng/ml” is not a “normal” in my opinion. Many ailments are associated with deficient vitamin D3 levels. It takes a very high level of 25-hydroxyvitamin D more in the range of 150 ng/ml before considered toxic. In my personal opinion men with prostate cancer should supplement with sufficient daily IU to reach and maintain a level within a range of 65 to 90 ng/ml. If deficient that could require upwards of a total 7,000 IU from all sources or more daily but suggest less than 10,000 daily. Even more important for the elderly and those who spend little time outdoors in sunlight. In any event, increased Vitamin D3 intake should be accompanied by regular monitoring of serum 25-hydroxyvitamin D, urine calcium levels, and parathyroid hormone level.

  5. Dear Chuck:

    You are entitled to your personal opinion, of course. However, neither the Institute of Medicine nor the National Institutes of Health come anywhere close to agreeing with you, and in all truth neither do I.


  6. The present recommended levels of vitamin D3 are based on bone health,to prevent diseases of the bone. I think the recommendations may be raised a bit in the near future. I have had two mainstream doctors recommend 45 to 50 ng/ml for optimum health, relating to patients who did not have cancer. It is true that men of color have a higher rate of prostate cancer and many times a more aggressive form. They usually have lower levels of vitamin D3, possibly due to lower vitamin D skin absorption. Many studies also show that men who live in warmer climates obtaining more sun exposure have lower rates of prostate cancer, same regarding women with breast cancer.

    It is a controversial topic presently and hopefully more information will be revealed in the near future to help anyone suffering from disease. There is so much we do not fully understand about the human body. Maybe it is not agreement that is important, it is the discussion to know there are different “schools of thought”. That is how change comes about.

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