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Our patient’s clinical course suggests that high doses of B vitamins (FA/folate and vitamin Bseveral) may modulate the course of PSA failure in castrate-resistant/refractory prostate cancer. Our patient’s ingestion of large amounts of FA/folate and vitamin B12 was associated with PSA acceleration, while withdrawal of the supplements was associated with a significant PSA decline. Whether this result was secondary to the perturbation of the outlined metabolic interactions of B vitamers (Figure 2), due to DNA epimethylation with associated changes in gene expression, or due to other factors is unknown. Read more