Prostate cancer in Vitamin D's Points of View

Kyle J. Norton

Vitamin D is a fat-soluble secosteroids found in small amount in few foods, including salmon, mackerel, sardines and tuna. The vitamin plays an important role in modulation of cellular proliferation, apoptosis induction, tumor growth suppression and promotion in absorption of minerals, including calcium, iron, magnesium, phosphate and zinc.

The widespread of prostate cancer, once considered as a disease of aging male, now have become major concerns of governments and scientific community in South East Asian with tendency to spread to younger age population. Suggestions emerged of over consuming bad fats in any time in history accompanied with unhealthy diet and life style may be the possible causes of the disease, linking to the economic prosperity over 2 decades. Herbal medicine for diseases' management have been prescribed in folk medicine over thousands of year as one of best medicine of nature in preventing and treating diseases, including prostate cancer.

Genetic mutation
Genetic mutation of Vitamin D-deactivating enzyme CYP24A1may be associated to increased risk of prostate cancer. In a Korean cohort suggested that five CYP24A1 sequence variants (rs2248461,  rs2248359, rs602299, rs2585428, rs4809959 had a significant association with prostate cancer risk(1);
vitamin D receptor (VDR) gene (two VDR sequence variants (rs2408876 and rs2239182), may play an important role in the onset and progression of prostate cancer(2). Others study of vitamin D pathway genes, VDR, CYP27B1, and CYP24A1, in prostate cancer showed an conflict result of that genotypes of CYP27B1 and CYP24A1 were not associated with prostate cancer risk, but polymorphisms in the VDR gene may be(3)(4)(5). In common genetic variation of the calcium-sensing receptor(CaSR), the Harvard School of Public Health showed that CaSR may be involved in PCa progression(5a)

Vitamin D plasma
Suggestions of plasma used in measurement of risk of prostate have been controversial with many inconsistent results, epidemiologically. The population-based cohort study of 1476 prostate cancer patients to assess disease recurrence/progression and prostate cancer-specific mortality (PCSM) risks associated with serum levels of 25(OH) vitamin D [25(OH)D], showed no evidence of serum vitamin D levels measured after diagnosis associated to prostate cancer prognosis(6) and  according to the Oregon Health & Science University prospective cohort of older men also found no association between serum 25-OH vitamin D levels and subsequent risk of prostate cancer.(6a). But according to the Harvard Medical School, suboptimal vitamin D status (especially during the winter/spring season), and both 25(OH)D and 1,25(OH)2D may play an important role in preventing prostate cancer progression(7) and  higher prediagnostic plasma 25(OH)D might be associated with improved prostate cancer prognosis(8).
In the variation of  above, some researchers suggested that  plasma 25(OH)D levels associated to common variation among several vitamin D-related genes((CYP27A1, CYP2R1, CYP27B1, GC, CYP24A1, RXRA, and VDR) and calcium-sensing receptor (CaSR)were associated with lethal prostate cancer risk(9)(10)(11). A report of survival in veterans with prostate cancer indicated a veterans who are initially vitamin D deficient and both initial and follow-up vitamin D deficiency are associated with decreased likelihood of survival after prostate cancer diagnosis(12). Other suggestions, linking vitamin D in reduced risk of prostate cancer and  prostate cancer-related health disparities in African-American men were greatly involved at least in part the result of widespread hypovitaminosis D within the African-American population.(15).

The efficacy
Vitamin D most active form, 1,25D(3) in an experiment of a stable prostate cancer cell line PC3 with CYP24A1 promoter inhibited gene expression of CYP24A1 through enhancement and regulation of  a protein kinase CK2 selective inhibitor(13); exhibited tumor suppressive miRNAs in patient prostate tissue, thus decreased proliferation in primary cells and cancer cells and suppressed migration and clonal growth of prostate cancer cell in a miRNA-dependent manner(14). A report from the Medical University of South Carolina, showed that vitamin D(3) supplementation at 4000 IU/d for 1 year, in patients with low-risk prostate cancer under active surveillance may benefit from vitamin D(3) supplementation(16) and eliminated any significant differences in circulating concentrations of 25(OH)D between African American and white men(17). Unfortunately, the University of Oslo study within Norwegian health studies indicated a increased risk of prostate cancer related to a high 25(OH)D concentration only during the summer and autumn due to vitamin D itself or to other factors associated with sun exposure(18). The discrepancy between the results of studies of solar exposure and studies of serum 25-OHD may be related to methodological differences and to uncertainties regarding the critical period for vitamin D exposure(19).  Low levels of UV radiation/vitamin D are indeed associated with an increased risk of prostate cancer in individual men(20).

Taking altogether, without going into reviews, although it is controversial, vitamin D may be effectively and selectively in reduced risk and treatment for prostate cancer in hypovitamin D deficient men and without exposure to UV sunlight and the disagreement of amount of vitamin D intake and plasma level in reduced risk and treatment of prostate cancer may still need further studies. Over doses of vitamin D supplement may cause excessive calcium absorption, calcification, Urinary stones etc. please make sure to follow the guideline of the Institute of Medicine of the National Academies.


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References
(1) Genetic variants in the CYP24A1 gene are associated with prostate cancer risk and aggressiveness in a Korean study population. by Oh JJ¹, Byun SS², Lee SE², Hong SK², Jeong CW², Choi WS³, Kim D⁴, Kim HJ⁵, Myung SC⁶(PubMed)
(2) Genetic variations in VDR associated with prostate cancer risk and progression in a Korean population by Oh JJ, Byun SS, Lee SE, Hong SK, Jeong CW, Kim D, Kim HJ, Myung SC(PubMed)
(3) Comprehensive association analysis of the vitamin D pathway genes, VDR, CYP27B1, and CYP24A1, in prostate cancer by Holick CN, Stanford JL, Kwon EM, Ostrander EA, Nejentsev S, Peters U.(PubMed)
(3) Genetic variants in the vitamin d receptor are associated with advanced prostate cancer at diagnosis: findings from the prostate testing for cancer and treatment study and a systematic review by Chen L, Davey Smith G, Evans DM, Cox A, Lawlor DA, Donovan J, Yuan W, Day IN, Martin RM, Lane A, Rodriguez S, Davis M, Zuccolo L, Collin SM, Hamdy F, Neal D, Lewis SJ(PubMed)
(5) Review and meta-analysis on vitamin D receptor polymorphisms and cancer risk by Raimondi S, Johansson H, Maisonneuve P, Gandini S(PubMed)
(5a) Common genetic variation of the calcium-sensing receptor and lethal prostate cancer risk by Shui IM, Mucci LA, Wilson KM, Kraft P, Penney KL, Stampfer MJ, Giovannucci E(PubMed)

(6) Circulating levels of 25-hydroxyvitamin D and prostate cancer prognosis by Holt SK, Kolb S, Fu R, Horst R, Feng Z, Stanford JL.(PubMed)
(7) A prospective study of plasma vitamin D metabolites, vitamin D receptor polymorphisms, and prostate cancer by Li H, Stampfer MJ, Hollis JB, Mucci LA, Gaziano JM, Hunter D, Giovannucci EL, Ma J(PubMed)
(8) Prediagnostic plasma vitamin D metabolites and mortality among patients with prostate cancer by Fang F, Kasperzyk JL, Shui I, Hendrickson W, Hollis BW, Fall K, Ma J, Gaziano JM, Stampfer MJ, Mucci LA, Giovannucci E(PubMed)
(9) Vitamin D-related genetic variation, plasma vitamin D, and risk of lethal prostate cancer: a prospective nested case-control study by Shui IM, Mucci LA, Kraft P, Tamimi RM, Lindstrom S, Penney KL, Nimptsch K, Hollis BW, Dupre N, Platz EA, Stampfer MJ, Giovannucci E(PubMed)
(10) Common genetic variation of the calcium-sensing receptor and lethal prostate cancer risk by Shui IM, Mucci LA, Wilson KM, Kraft P, Penney KL, Stampfer MJ, Giovannucci E(PubMed)
(11) Vitamin D-related genes, serum vitamin D concentrations and prostate cancer risk by Ahn J, Albanes D, Berndt SI, Peters U, Chatterjee N, Freedman ND, Abnet CC, Huang WY, Kibel AS, Crawford ED, Weinstein SJ, Chanock SJ, Schatzkin A, Hayes RB; Prostate, Lung, Colorectal and Ovarian Trial Project Team(PubMed)
(12)Vitamin d and prostate cancer survival in veterans by Der T¹, Bailey BA², Youssef D¹, Manning T³, Grant WB⁴, Peiris AN(PubMed)
(13) Inhibition of protein kinase CK2 reduces Cyp24a1 expression and enhances 1,25-dihydroxyvitamin D(3) antitumor activity in human prostate cancer cells by Luo W, Yu WD, Ma Y, Chernov M, Trump DL, Johnson CS.(PubMed)
(14) Tumor suppressor microRNAs, miR-100 and -125b, are regulated by 1,25-dihydroxyvitamin D in primary prostate cells and in patient tissue by Giangreco AA, Vaishnav A, Wagner D, Finelli A, Fleshner N, Van der Kwast T, Vieth R, Nonn L.(PubMed)
(15) Vitamin D3 supplementation, low-risk prostate cancer, and health disparities by Hollis BW, Marshall DT, Savage SJ, Garrett-Mayer E, Kindy MS, Gattoni-Celli S(PubMed)
(16) Vitamin D3 supplementation at 4000 international units per day for one year results in a decrease of positive cores at repeat biopsy in subjects with low-risk prostate cancer under active surveillance by Marshall DT, Savage SJ, Garrett-Mayer E, Keane TE, Hollis BW, Horst RL, Ambrose LH, Kindy MS, Gattoni-Celli S.(PubMed)
(17) Vitamin D3 supplementation (4000 IU/d for 1 y) eliminates differences in circulating 25-hydroxyvitamin D between African American and white men by Garrett-Mayer E, Wagner CL, Hollis BW, Kindy MS, Gattoni-Celli S.(PubMed)
(18) Vitamin D, season, and risk of prostate cancer: a nested case-control study within Norwegian health studies by Meyer HE, Robsahm TE, Bjørge T, Brustad M, Blomhoff R.(PubMed)
(19) Vitamin D, sunlight, and the epidemiology of prostate cancer by Schwartz GG.(PubMed)
(20) Vitamin D and the epidemiology of prostate cancer by Schwartz GG.(PubMed)