title: Calcium and phosphorus intake and prostate cancer risk: a 24-y follow-up study.
abstract: BACKGROUND
  High calcium intake has been associated with an increased risk of advanced-stage and high-grade prostate cancer. Several studies have found a positive association between phosphorus intake and prostate cancer risk.
  
  
  OBJECTIVE
  We investigated the joint association between calcium and phosphorus and risk of prostate cancer in the Health Professionals Follow-Up Study, with a focus on lethal and high-grade disease.
  
  
  METHODS
  In total, 47,885 men in the cohort reported diet data in 1986 and every 4 y thereafter. From 1986 to 2010, 5861 cases of prostate cancer were identified, including 789 lethal cancers (fatal or metastatic). We used Cox proportional hazards models to assess the association between calcium and phosphorus intake and prostate cancer, with adjustment for potential confounding.
  
  
  RESULTS
  Calcium intakes >2000 mg/d were associated with greater risk of total prostate cancer and lethal and high-grade cancers. These associations were attenuated and no longer statistically significant when phosphorus intake was adjusted for. Phosphorus intake was associated with greater risk of total, lethal, and high-grade cancers, independent of calcium and intakes of red meat, white meat, dairy, and fish. In latency analysis, calcium and phosphorus had independent effects for different time periods between exposure and diagnosis. Calcium intake was associated with an increased risk of advanced-stage and high-grade disease 12-16 y after exposure, whereas high phosphorus was associated with increased risk of advanced-stage and high-grade disease 0-8 y after exposure.
  
  
  CONCLUSIONS
  Phosphorus is independently associated with risk of lethal and high-grade prostate cancer. Calcium may not have a strong independent effect on prostate cancer risk except with long latency periods.
authors.affiliation: From the Departments of Epidemiology (KMW, IMS, LAM, and EG) and Nutrition (EG), Harvard School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, and Harvard Medical School, Boston, MA (KMW, LAM, and EG).
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Wilson
authors.affiliation: From the Departments of Epidemiology (KMW, IMS, LAM, and EG) and Nutrition (EG), Harvard School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, and Harvard Medical School, Boston, MA (KMW, LAM, and EG).
authors.forename: Irene M
authors.initials: IM
authors.lastname: Shui
authors.affiliation: From the Departments of Epidemiology (KMW, IMS, LAM, and EG) and Nutrition (EG), Harvard School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, and Harvard Medical School, Boston, MA (KMW, LAM, and EG).
authors.forename: Lorelei A
authors.initials: LA
authors.lastname: Mucci
authors.affiliation: From the Departments of Epidemiology (KMW, IMS, LAM, and EG) and Nutrition (EG), Harvard School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, and Harvard Medical School, Boston, MA (KMW, LAM, and EG).
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
mesh_terms: D000328:Adult; D000368:Aged; D002136:Calcium, Dietary / Q000009:adverse effects*; D015331:Cohort Studies; D003611:Dairy Products / Q000009:adverse effects; D019587:Dietary Supplements / Q000009:adverse effects; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D008297:Male; D008460:Meat / Q000009:adverse effects; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016226:Phosphorus, Dietary / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D002136:Calcium, Dietary; D016226:Phosphorus, Dietary
keywords: calcium; diet; epidemiology; fatal prostate cancer; high-grade prostate cancer; nutritional epidemiology; phosphorus; prostate cancer