Vitamin D and adverse pathologic features in patients undergoing radical prostatectomy in the contemporary magnetic resonance imaging-guided management era

Objective: This study aimed to evaluate the association between serum 25-hydroxyvitamin D (25-OH D) levels and adverse pathologic features in patients undergoing radical prostatectomy (RP) in the contemporary magnetic resonance imaging (MRI)-guided management era. Methods: This retrospective study included patients who underwent RP between January 2022 and December 2024 at a single academic centre. Preoperative MRI was routinely incorporated into staging and treatment planning. Serum 25-OH D levels measured within 3 months prior to surgery were analysed. Vitamin D insufficiency was defined as 20–29.99 ng/mL and deficiency as <20 ng/mL. Adverse pathologic features included International Society of Urological Pathology (ISUP) Grade Group 4 or 5, extraprostatic extension (EPE), seminal vesicle invasion (SVI) and pelvic lymph node metastasis. Associations were evaluated using multivariable logistic regression analysis. Results: A total of 217 patients were included. Preoperative MRI was performed in 96.0% of patients and MRI-targeted biopsy in 78.3%. Adverse pathologic features were identified in 66.4% of patients. Vitamin D insufficiency and deficiency were present in 67.3% and 17.5%, respectively. Mean serum 25-OH D levels did not differ significantly between patients with and without adverse pathology (28.19 ± 8.41 ng/mL vs. 27.46 ± 9.26 ng/mL, p = 0.55). In multivariable analysis, body mass index and adverse MRI findings were independently associated with adverse pathology, whereas serum 25-OH D levels were not. An exploratory subgroup analysis demonstrated an association between serum 25-OH D levels and EPE in very-high-risk patients. Conclusion: Serum 25-OH D levels were not independently associated with adverse pathologic features following RP in this contemporary MRI-guided management cohort. While established clinical and radiologic factors remain the primary predictors of adverse pathology, further studies are needed to clarify the role of vitamin D in long-term oncologic and functional outcomes.