High-dose vitamin D supplementation and prostate cancer progression: a phase II randomised trial in localised prostate cancer cases with intermediate risk of progression (ProsD)

Abstract

Background The ProsD trial aimed to determine if oral vitamin D supplementation could prevent prostate cancer ( PC ) progression in men on active surveillance ( AS ).

Methods ProsD is a phase-II double-blinded randomized trial of newly diagnosed, low-intermediate risk PC cases, aged between 50 and 80 years and on AS. The intervention was a monthly oral dose of cholecalciferol (50,000IU; Vitamin D) or placebo. Primary and secondary endpoints were active therapy-free ( ATFS ) and progression-free ( PFS ) survival, respectively. Blood samples were analysed for vitamin D metabolites and cytokinesis-block micronucleus cytome (CBMN) markers for lymphocytic genome damage.

Results There were 123 randomised participants (81 vitamin D and 42 placebo) included in this analysis. Mean (SD) for age was 66.5 (6.6) years and for 25(OH)D levels were 72.0 (19.9) and 66.4 (18.4) nmol/L at baseline ( p = 0.1), and 91.9 (19.9) and 60.4 (24.4) nmol/L at 24 months, in the vitamin D and placebo arms respectively. There were no appreciable differences in ATFS (p log-rank = 0.44), PFS (p p log-rank = 0.60) and occurrence of adverse events, in each trial arm. There were declines in some of the lymphocytic CBMN markers in the vitamin D arm.

Conclusion Vitamin D supplementation did not prevent PC progression, although reduced prevalence of CBMN markers may indicate a benefit of vitamin D supplementation.

Trial registration Australia New Zealand Clinical Trials Registry (ACTRN12616001707459).

Key points

Findings: In this phase 2 randomised trial involving 123 prostate cancer patients with low-intermediate risk of progression, vitamin D supplementation did not prevent patients discontinuing active surveillance in favour of active therapy. However, vitamin D supplementation reduced prevalence of lymphocytic genome damage markers that are predictors of cancer risk.

Meaning: Vitamin D supplementation may not prevent progression of well-developed prostate cancers, however reduction in the prevalence of lymphocytic genome damage in the vitamin D arm of the study suggests an anti-cancer effect that may prevent the initiation of new cancers.