Castration-Resistant Prostate Cancer

Castration-resistant prostate cancer (CRPC) is a progressive, noncurable form of prostate cancer that continues to grow despite castrate levels of testosterone, typically marked by rising prostate-specific antigen (PSA) levels. It is driven by persistent androgen receptor (AR) signaling, even in low-androgen environments, often through intracrine androgen synthesis from adrenal precursors like dehydroepiandrosterone (DHEA). Metastatic CRPC (mCRPC) remains a major therapeutic challenge, though calcitriol—the active metabolite of vitamin D—has demonstrated anti-tumor effects in preclinical models via induction of cell cycle arrest, apoptosis, differentiation, and inhibition of angiogenesis and metastasis. These effects are mediated by the vitamin D receptor (VDR), which interacts with AR signaling pathways; notably, androgens suppress CYP24A1 (a calcitriol-degrading enzyme), while vitamin D promotes androgen inactivation through induction of metabolic enzymes like CYP3A4 and SULT2B1b. However, these protective mechanisms are disrupted in advanced disease, where CYP24A1 is overexpressed and CYP3A4/SULT2B1b are downregulated. Emerging evidence supports the potential of safe-dose vitamin D3 supplementation in slowing low-grade prostate cancer progression, and future strategies may involve combining next-generation calcitriol analogs with CYP24A1 inhibitors or agents targeting cancer stem cells, such as sulforaphane, to enhance therapeutic efficacy.