title: Vitamin D, PTH, and calcium in relation to survival following prostate cancer.
abstract: OBJECTIVE
  Epidemiological studies suggest that low levels of vitamin D constitute a risk factor for prostate cancer. However, the results are conflicting, perhaps because prostate cancer is a very heterogeneous disease. More recent studies have focused on cancer progression and mortality. Vitamin D is closely related to both calcium metabolism and parathyroid hormone (PTH) levels, and all three factors have been implicated in prostate cancer.
  
  
  METHODS
  We examined the associations between pre-diagnostic serum levels of vitamin D (25OHD), PTH, and calcium and mortality among 943 participants within the Malmö Diet and Cancer Study, who were diagnosed with prostate cancer. The mean time from diagnosis until the end of followup was 9.1 years (SD 4.5), and the mean time from inclusion until end of follow-up was 16.6 years (SD 4.9). The analytes were divided into quartiles, and the risk of death from prostate cancer was analyzed using Cox proportional hazard analysis, yielding hazards ratios (HR) with 95 % confidence intervals. The models were adjusted for season and year of inclusion, age at baseline, age at diagnosis, body mass index (BMI), and tumor characteristics (TNM and Gleason score).
  
  
  RESULTS
  We observed a trend toward a lower prostate-specific mortality with 25OHD >85 nmol/L in the unadjusted analysis. This became statistically significantly in the third quartile of 25OHD (85-102 nmol/L) compared to the first (<68 nmol/L), HR 0.54 (0.34-0.85) when adjusting for age, time of inclusion, and BMI. The association was further strengthened when adjusted for age at diagnosis, Gleason score, and TNM classification with a HR in Q3 0.36 (0.22-0.60). p for trend was 0.03. Regarding calcium, there was a significantly lower HR for the second quartile (2.35-2.39 mmol/L) compared to the first (≤2.34 mmol/L) with a HR of 0.54 (0.32-0.86) in the unadjusted analysis. However, this association disappeared when adjusting for tumor characteristics. There were no associations between levels of PTH and prostate cancer mortality.
  
  
  CONCLUSIONS
  This study shows that levels of pre-diagnostic vitamin D above 85 nmol/L may improve survival in men with prostate cancer.
authors.affiliation: Department of Urology, Skåne University Hospital Malmö, Lund University, 205 02, Malmö, Sweden. johan.brandstedt@skane.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Brändstedt
authors.affiliation: Department of Surgery, Skåne University Hospital Lund, Lund University, Malmö, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Almquist
authors.affiliation: Department of Plastic Surgery, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.affiliation: Department of Translational Medicine, Section for Clinical Chemistry, Skåne University Hospital, Lund University, Malmö, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Malm
mesh_terms: D000368:Aged; D002118:Calcium / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality*; D012307:Risk Factors; D012621:Seasons; D013548:Sweden / Q000453:epidemiology; D014807:Vitamin D / Q000097:blood*; D014815:Vitamins
chemical_list: D010281:Parathyroid Hormone; D014815:Vitamins; D014807:Vitamin D; D002118:Calcium
keywords: Calcium; Mortality; PTH; Prostate cancer; Vitamin D