Prostate cancer is the third most common cancer worldwide. While studies in Western populations suggest an association between low Vitamin D levels and aggressive prostate cancer, this relationship remains unclear in Asian population.

This retrospective study included patients who underwent radical prostatectomy (robot-assisted, laparoscopic, or open surgery) between 2022 and 2024. Serum 25-OH D levels were measured within three months before surgery, and pathology reports were reviewed for adverse features. Statistical analysis assessed the relationship between Vitamin D levels and adverse pathology.

A total of 217 patients were included (3 open prostatectomy, 69 laparoscopic radical prostatectomy, and 145 robotic-assisted laparoscopic radical prostatectomy). The mean patient age was 67 years. Most patients (96.3%) underwent preoperative MRI. The 2024 NCCN risk group distribution was Very Low Risk (1.3%), Low Risk (5.5%), Intermediate Risk (17.5%), High Risk (42.4%), and Very High Risk (22.6%). Adverse pathology was present in 144 patients. The mean serum Vitamin D level was 27.46 ± 9.26 ng/mL in the adverse pathology group and 28.19 ± 8.41 ng/mL in the non-adverse pathology group, showing no significant difference (p = 0.55). Subgroup analysis suggested a potential association between Vitamin D levels and extraprostatic extension in the very high-risk group (35.42 ± 7.13 vs. 27.34 ± 7.71 ng/mL, p = 0.019).

This study found no significant association between serum Vitamin D levels and adverse pathological features in prostate cancer patients undergoing radical prostatectomy. These findings contrast with previous research and may be attributed to the increasing use of MRI-guided fusion biopsy, which enhances staging accuracy and influences treatment decisions. Furthermore, this study highlights the high prevalence of Vitamin D insufficiency among Thai patients, emphasizing the need for further research on its potential implications for prostate cancer management and overall health.