Department of Urology, Charité-Universitätsmedizin Berlin, Germany; Berlin Institute for Urologic Research, Berlin, Germany.
Department of Urology, Sana Hospital, Offenbach, Germany.
J Urol. 2016 Sep;196(3):709-14. doi: 10.1016/j.juro.2016.03.009. Epub 2016 Mar 11.
We evaluated the usefulness of serum 25-hydroxyvitamin D as a marker of aggressive prostate cancer and for active surveillance compared to PHI (Prostate Health Index).
Of 480 prospectively biopsied men 222 had prostate cancer and 258 had no evidence of malignancy. In all men prostate specific antigen was less than 20 ng/ml. We measured 25-hydroxyvitamin D, prostate specific antigen, free prostate specific antigen and -2proPSA using a commercially available immunoassay system. PHI was calculated according to the equation, -2proPSA/free prostate specific antigen × √PSA. We determined 25-hydroxyvitamin D using a 2-step competitive binding immunoenzymatic vitamin D assay.
The 25-hydroxyvitamin D concentrations were not associated with Gleason grade according to the 2014 ISUP (International Society of Urological Pathology) consensus conference Gleason grading system. PHI values were higher with increasing Gleason grade. Median 25-hydroxyvitamin D did not differ between men with prostate cancer vs no evidence of malignancy (50.6 vs 48.2 nmol/l, p = 0.192) or in ISUP Gleason subgroups despite seasonal variations of 25-hydroxyvitamin D. However, PHI values significantly differed between the subgroup with no evidence of malignancy and all Gleason subgroups (p <0.0001). The ROCs of all men revealed an advantage of PHI over 25-hydroxyvitamin D (AUC 0.78 vs 0.535, p <0.0001). PHI could also significantly better separate patients with no evidence of malignancy from those with nonaggressive disease (ISUP Gleason grade 1) from those with aggressive prostate cancer (ISUP Gleason grades 2-5).
It remains highly improbable that 25-hydroxyvitamin D could be used as decision or selection marker for aggressive prostate cancer or for active surveillance compared to accepted markers, as recently suggested.
我们评估了血清 25-羟维生素 D 作为侵袭性前列腺癌标志物和主动监测指标的效用，并与 PHI（前列腺健康指数）进行了比较。
在 480 名前瞻性活检的男性中，222 名患有前列腺癌，258 名无恶性肿瘤证据。所有男性的前列腺特异性抗原均<20ng/ml。我们使用商业上可用的免疫分析系统测量了 25-羟维生素 D、前列腺特异性抗原、游离前列腺特异性抗原和-2 前列腺特异性抗原。PHI 是根据公式计算的，即-2 前列腺特异性抗原/游离前列腺特异性抗原×PSA 的平方根。我们使用两步竞争结合免疫酶维生素 D 测定法来确定 25-羟维生素 D 的浓度。
25-羟维生素 D 浓度与根据 2014 年国际泌尿病理学会（ISUP）共识会议 Gleason 分级系统的 Gleason 分级无关。PHI 值随 Gleason 分级的增加而升高。尽管 25-羟维生素 D 存在季节性变化，但患有前列腺癌与无恶性肿瘤证据的男性之间的中位 25-羟维生素 D 无差异（50.6 与 48.2nmol/L，p=0.192）或在 ISUP Gleason 亚组中。然而，PHI 值在无恶性肿瘤证据的亚组与所有 Gleason 亚组之间存在显著差异（p<0.0001）。所有男性的 ROC 显示 PHI 优于 25-羟维生素 D（AUC 0.78 与 0.535，p<0.0001）。PHI 还可以更好地区分无恶性肿瘤证据的患者与非侵袭性疾病（ISUP Gleason 分级 1）患者与侵袭性前列腺癌（ISUP Gleason 分级 2-5）患者。
与最近提出的可接受标志物相比，25-羟维生素 D 作为侵袭性前列腺癌或主动监测的决策或选择标志物的可能性仍然很小。
