Study: vitamin D and prostate cancer

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Reference tretli s, Hernes E, Berg JP, Hestvik Ue, Robsahm te. Association between Serum 25 (OH) D and death through prostate cancer. BR J Cancer. 2009; 100: 450-454. Design prospective case-cohorting association study participants, one hundred and sixty patients with histologically verified prostate cancer, who was diagnosed between 1984 to 2004 and donated serum samples to Norwegian Janus-Serumbank. The rehearsals were tested with a competitive radioimmunassay on circulating 25 (OH) D. The 25 (OH) D serum of the patient was categorized as follows: low (below 50 Nmol/l or 20 ng/ml), medium (50-80 NMOL/L or 20-32 ng/ml) and high (over 80 NMOL/L or 32 ng/ml). The patients were divided into 2 groups. Group 1 ...
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Reference

tretli s, hernes e, mountain jp, hestvik ue, robsahm te. Association between Serum 25 (OH) D and Death by prostate cancer. br j Krebs. 2009; 100: 450-454.

Design

prospective case cohort association study

participant

SECOND-SICHT Patients with histologically verified prostate cancer, who was diagnosed between 1984 to 2004 and donated serum samples to the Norwegian Janus Serumbank. The rehearsals were tested with a competitive radioimmunassay on circulating 25 (OH) D. The 25 (OH) D serum of the patient was categorized as follows: low (below 50 Nmol/l or 20 ng/ml), medium (50-80 NMOL/L or 20-32 ng/ml) and high (over 80 NMOL/L or 32 ng/ml). The patients were divided into 2 groups. Group 1 consisted of 37 patients who were treated with hormone treatment with androgen inhibitors, luteinizing hormone releasing hormone (LHRH) or castration before measuring the 25 (OH) D measurement. Group 2 consisted of 123 patients who were treatment naive at the time of 25 (OH) D measurement. After Group 2 25 (OH) D levels were measured, they underwent various treatments for their prostate cancer: 20 out of 123 patients received radiation therapy, 29 of 123 an operation, 60 out of 123 a hormone therapy and 14 out of 123 an unspecific treatment. When combining groups 1 and 2, a total of 97 patients received hormone therapy with androgen inhibitors, LHRH or castration before or during the study. From the date of the 25 (OH) D measurement to the date of death, migration or the end of the study (December 31, 2005), the participants were watched, depending on what occurred first. The participant's death and the cause of death were identified on the basis of the National dying register.

important knowledge

Serum-25 (OH) D at medium to high concentrations were significantly associated with a better prognosis and reduced mortality from prostate cancer compared to patients with low concentrations. The Hazard ratio for patients with medium and high serum-25 (OH) D levels was 0.48 or 0.35 with a confidence interval of 95 %. When the analysis was further restricted to patients who received hormone therapy, an even stronger association was found. If the analysis of age, tumor differentiation and functional status was adjusted, a not significantly lower risk of death by prostate cancer was observed for patients with high 25 (OH) D values.

clinical implications

In the United States, vitamin D is usually measured in NG/ml, but the standard internationally (Si) measures in NMOL/L. The conversion factor in SI units is 1 ng/ml = 2.496 NMOL/L. Evidence that show the importance of vitamin D in other disease states and types of cancer are increasing. There has already been a causal connection between the season of prostate cancer diagnosis and the forecast, which was assumed that it was related to the serum-25 (OH) D mirrors. 1 From a preventive medical point of view, this study shows the potential advantages of adequate vitamin D levels before a cancer diagnosis.
The authors of the study found that the majority of patients had a sufficient 25 (OH) D level for bone health. A meta-analysis that dealt with the optimal vitamin D serum mirrors showed that the optimal mirror can vary depending on the underlying disease or condition. 2 The ongoing research in this area continues. Interestingly, a study published in 2008 showed that high circulating 25 (OH) D can increase the risk of aggressive prostate cancer, 3 which indicates that there may be a "sweet spot" in the desired serum area. Another study showed an increased risk of prostate cancer if the Serum-25 (OH) D-value was below 19 NMOL/L (8 ng/ml) or over 80 NMOL/L (32 ng/ml). It is therefore recommended to add a lack of vitamin D with caution in the direction of the upper limit over 80 NMOL/L (32 ng/ml).
It is interesting to determine that the men who were treated with hormone therapy had a greater connection between vitamin D levels and forecast. Men who receive androgen-suppressant therapies also have a higher risk of osteoporosis and fractures. 5 This would be an excellent indication for serum-25 (OH) D-level tests in addition to dexa scans and other bone density markers.
Although it is not known whether a supplement with vitamin D after diagnosis affects the forecast or the result, vitamin D is currently being examined in combination with chemotherapy in order to increase the effectiveness of the treatment of metastatic prostate cancer. The use of high -dose calcitriol has proven to be promising for an improved reaction in combination with Docetaxel.

restrictions

Although this study is convincing, it has several restrictions that prevent an immediate change in the proven procedure for prostate cancer. One of the main restrictions is the sample size. A study with 160 patients is not big enough to draw general conclusions about the total population. Due to the low sample size, the majority of the patients included in this study were treated with hormone therapy and relatively few were treated with surgery or radiation therapy. A larger sample size can help reduce the distortion of treatment in the mortality results.
Another weak point was the duration of the observation of the participants, who were on average 44 months. The global 5-year survival rate for prostate cancer is between 40 % and 80 %, and the duration of progress from prostate cancer diagnosis to the death of prostate cancer can be more than 10 years.
In addition, some patients included in this study had received hormone treatment before rehearsal. It is not known whether hormone treatment can influence the 25 (OH) D levels in the serum. This patient sub -group had a metastatic disease compared to the group that was not previously treated. A better study design would have excluded patients who had previously been treated with hormone manipulations, operations, chemotherapy or radiation therapy.
While this study shows a strong connection between prostate cancer mortality and Serum-25 (OH) D mirror, association studies do not show causality or the need for treatment intervention with a supplementation of vitamin D. Larger studies are required to the connection between serum-25 (OH) D and prostate cancellation. As soon as this connection is established, further studies that use randomization to obtain vitamin D with standard cancer treatment would help to clarify the role of vitamin D supplement in patients with diagnosed prostate cancer.

  1. Lagunova Z, Porojnicu AC, Dahlback A, Berg JP, Beer TM, Moan J. The survival of prostate cancer depends on the season of diagnosis. prostate. 2007; 67 (12): 1362-1370.
  2. Bischoff-Ferrari Ha, Giovannucci e, Willet toilet, Dietrich T, Watson-Hughes B. estimate of the optimal serum concentration of 25-hydroxyvitamin D for several health results. Am J Clin . 2006; 84: 18-28.
  3. Ahn J., Peters U., Albanes D., et al. Serum vitamin D concentration and prostate cancer risk: a nested case control study. j National Cancer Inst. 2008; 100: 796-804.
  4. tuohimaa P., Tenkanen L., Ahonen M. et al. Both high and low blood vitamin D levels are associated with a higher risk of prostate cancer: a nested case-control longitudinal study in the Nordic countries. Int j Krebs. 2004; 108 (1): 104-108.
  5. Diamond Th, Bucci J, Kersley JH, Aslan P, Lynch WB, Bryant C. Osteoporosis and spine fractures in men with prostate cancer: risk factors and effects of androgen withdrawal therapy. j urol . 2004; 172 (2): 529-532.
  6. Beer TM, Ryan, CW, Venner PM, et al. Double-blind, randomized study with Calcitriol plus Docetaxel compared to placebo plus Docetaxek for androgen-independent cancer: a report by the ascent investigators. J clin oncol. 2007; 25 (6): 669-674.
  7. Hershberger Pa, Yu WD, Modzelewski RA, Rueger RM, Johnson CS, Trump DL. Calcitriol (1,25-dihydroxycholecalciferol) increases the antitumor activity of paclitaxel in vitro and in vivo and accelerates the apoptosis induced by paclitaxel. Clinic Cancer Res. 2001; 7 (4): 1043-1051.
  8. American cancer society. Global facts and numbers. 2007.