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BJU International Volume 100 Issue 6 Page 1411-1411, December 2007 CALCIUM SUPPLEMENTS IN PATIENTS WITH PROSTATE CANCER •Chidi N. Molokwu •Urology Research Fellow, Academic Urology Unit, University of Sheffield Medical School, Sheffield, UK I refer to a recent article [1] reporting the findings on the relationship between daily calcium intake (DCI) AND the risk of osteoporosis in men receiving androgen-deprivation therapy (ADT). The authors found that osteoporosis was more common in men with a lower DCI. They went on to recommend a DCI of >1000 mg to reduce the risk of osteoporosis AND subsequent complications. I applaud the authors for their work. The findings are very valuable, as the study highlights osteoporosis as one of the risks of ADT, AND shows a link between DCI AND osteoporosis. However, they have only focused the role of a high DCI in preventing osteoporosis in patients with prostate cancer receiving ADT, AND not mentioned the possible risks associated with increasing DCI in this group of patients. The use of calcium supplements in men with prostate cancer might have undesirable effects. While a high DCI will reduce the risk of developing osteoporosis, could it have an adverse effect by favouring disease progression? Several studies have shown an association between high dairy product AND calcium intake, AND the increased risk of developing prostate cancer [2–4]. Further analysis of the data in one of these studies [4] found that the association was stronger in tumours with high Gleason grades. Studies at the cellular level have identified several pro-tumour effects of calcium, including cell motility AND angiogenesis [5]. A better approach to reducing the incidence of osteoporosis might be to use bisphosphonates; these increase bone mineral density (BMD) in men with prostate cancer receiving ADT [6,7], AND have a tumoricidal effect by inducing apoptotic cell death of prostate cancer cells [8]. Until the controversies surrounding the role of calcium in prostate cancer progression are settled, it would be wise to advocate a cautious approach to advising men with prostate cancer about increasing their DCI.

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