Association of Vitamin D and Prostate Health Status in Men: An Analytical Cross-Sectional Study.

Introduction: Benign prostatic hyperplasia (BPH) is the most common form of lower urinary tract symptoms (LUTS). Vitamin D may be an effective way to treat BPH symptoms because it has anti-proliferative and anti-inflammatory characteristics. Thus, adequate vitamin D levels are vital for overall health. This study aimed to investigate the association of vitamin D with prostate health status in men and determine the diagnostic cut-off of vitamin D levels.  Methods: This analytical cross-sectional study was conducted among men between 45 and 80 years of age who presented to the surgery or urology department with complaints of frequent urination and urinary tract infection. Based on their total prostate-specific antigen (PSA) levels, the participants were categorized into four groups - Group A (total PSA 0-3.9 ng/ml), Group B (total PSA 4-9.9 ng/ml), Group C (total PSA 10 - 19.9 ng/ml), and Group D (total PSA > 20 ng/ml). Total PSA was estimated by a dedicated Beckman Coulter hormone analyzer (UNICEL DXI 600, Beckman Coulter, Inc., California, US) via the chemiluminescence method. Serum vitamin D was estimated with dedicated reagents in the Bio-Rad ELISA (Bio-Rad Laboratories, Inc., California, US). An analysis of variance (ANOVA) post hoc test was utilized to compare quantitative variables. A correlation analysis proved the relation between vitamin D and total PSA. The receiver operating characteristic (ROC) curve was utilized to determine the diagnostic performance of the analyte of interest.

Results: In this study, total PSA levels significantly increased in men over 75 years of age. The upper limit of total PSA increased with the age of the men. Total PSA levels were compared between the age groups of 40 to 49, 50 to 59, 60 to 69, and more than 70, and an increase in total PSA levels was observed in those between 60 and 69 years. Total PSA levels were also negatively correlated (r=- 0.31) with vitamin D in this age group. Moreover, vitamin D-deficient individuals had significantly increased total PSA levels (12.57±5.22 ng/ml). Further correlation analysis revealed a significant negative correlation of total PSA with vitamin D levels (r=- 0.245; p=0.022). ROC analysis had an area under the curve of 0.828 for Vitamin D at a cut-off of 20 ng/ml revealing a diagnostic sensitivity of 86% and specificity of 60%.  Conclusion: Vitamin D deficiency is a potential biochemical marker of benign prostate hypertrophy. Vitamin D and total PSA are indicators of prostate health status in men. Screening of total PSA levels reflects the prostate health status of men and this needs to be potentiated with vitamin D supplementation.