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Importance: Determination of optimal treatment durations for common infectious diseases is an important strategy to preserve antibiotic effectiveness.Objective: To determine whether 7 days of treatment is noninferior to 14 days when using ciprofloxacin or trimethoprim/sulfamethoxazole to treat urinary tract infection (UTI) in afebrile men.Design, Setting, and Participants: Randomized, double-blind, placebo-controlled noninferiority trial of afebrile men with presumed symptomatic UTI treated with ciprofloxacin or trimethoprim/sulfamethoxazole at 2 US Veterans Affairs medical centers (enrollment, April 2014 through December 2019; final follow-up, January 28, 2020). Of 1058 eligible men, 272 were randomized.Interventions: Participants continued the antibiotic prescribed by their treating clinician for 7 days of treatment and were randomized to receive continued antibiotic therapy (n = 136) or placebo (n = 136) for days 8 to 14 of treatment.Main Outcomes and Measures: The prespecified primary outcome was resolution of UTI symptoms by 14 days after completion of active antibiotic treatment. A noninferiority margin of 10% was selected. The as-treated population (participants who took ≥26 of 28 doses and missed no more than 2 consecutive doses) was used for the primary analysis, and a secondary analysis included all patients as randomized, regardless of treatment adherence. Secondary outcomes included recurrence of UTI symptoms and/or adverse events within 28 days of stopping study medication.Results: Among 272 patients (median [interquartile range] age, 69 [62-73] years) who were randomized, 100% completed the trial and 254 (93.4%) were included in the primary as-treated analysis. Symptom resolution occurred in 122/131 (93.1%) participants in the 7-day group vs 111/123 (90.2%) in the 14-day group (difference, 2.9% [1-sided 97.5% CI, -5.2% to ∞]), meeting the noninferiority criterion. In the secondary as-randomized analysis, symptom resolution occurred in 125/136 (91.9%) participants in the 7-day group vs 123/136 (90.4%) in the 14-day group (difference, 1.5% [1-sided 97.5% CI, -5.8% to ∞]) Recurrence of UTI symptoms occurred in 13/131 (9.9%) participants in the 7-day group vs 15/123 (12.9%) in the 14-day group (difference, -3.0% [95% CI, -10.8% to 6.2%]; P = .70). Adverse events occurred in 28/136 (20.6%) participants in the 7-day group vs 33/136 (24.3%) in the 14-day group.Conclusions and Relevance: Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was noninferior to 14 days of treatment with regard to resolution of UTI symptoms by 14 days after antibiotic therapy. The findings support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to a 14-day course for treatment of afebrile men with UTI.Trial Registration: ClinicalTrials.gov identifier: NCT01994538. [ABSTRACT FROM AUTHOR]

The article discusses a study by D. M. Drekonja et al which reports findings from a randomized clinical trial that evaluated the non-inferiority of seven days of antibiotic therapy with ciprofloxacin or trimetho-prim/sulfamethoxazole to 14-days of therapy for outpatient men with clinical urinary tract infection (UTI) in the U.S. Topics include why male UTIs are considered complicated compared to that of women and the adverse events reported among trial participants in the 7-day treatment group.

Importance The use of advanced treatment technologies (ie, intensity-modulated radiotherapy [IMRT] and robotic prostatectomy) for prostate cancer is increasing. The extent to which these advanced treatment technologies have disseminated among patients at low risk of dying from prostate cancer is uncertain. Objective To assess the use of advanced treatment technologies, compared with prior standards (ie, traditional external beam radiation treatment [EBRT] and open radical prostatectomy) and observation, among men with a low risk of dying from prostate cancer. Design, Setting, and Patients Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified a retrospective cohort of men diagnosed with prostate cancer between 2004 and 2009 who underwent IMRT (n=23 633), EBRT (n =3926), robotic prostatectomy (n = 5881), open radical prostatectomy (n = 6123), or observation (n = 16 384). Follow-up data were available through December 31,2010. Main Outcomes and Measures The use of advanced treatment technologies among men unlikely to die from prostate cancer, as assessed by low-risk disease (clinical stage ≤T2a, biopsy Gleason score ≤6, and prostate-specific antigen level ≤10 ng/mL), high risk of noncancer mortality (based on the predicted probability of death within 10 years in the absence of a cancer diagnosis), or both. Results In our cohort, the use of advanced treatment technologies increased from 32% (95% CI, 30%-33%) to 44% (95% CI, 43%-46%) among men with low-risk disease (P<.001) and from 36% (95% CI, 35%-38%) to 57% (95% CI, 55%-59%) among men with high risk of noncancer mortality (P<.001). The use of these advanced treatment technologies among men with both low-risk disease and high risk of noncancer mortality increased from 25% (95% CI, 23%-28%) to 34% (95% CI, 31%-37%) (P<.001). Among all patients diagnosed in SEER, the use of advanced treatment technologies for men unlikely to die from prostate cancer increased from 13% (95% CI, 12%-14%), or 129.2 per 1000 patients diagnosed with prostate cancer, to 24% (95% CI, 24%-25%), or 244.2 per 1000 patients diagnosed with prostate cancer (P < .001). Conclusion and Relevance Among men diagnosed with prostate cancer between 2004 and 2009 who had low-risk disease, high risk of noncancer mortality, or both, the use of advanced treatment technologies has increased. [ABSTRACT FROM AUTHOR]

The article focuses on a research study in which researchers examined examine racial and sex differences in incident total coronary heart disease (CHD), fatal CHD, and nonfatal CHD across race-sex groups in the U.S. They examined whether risk factors were associated with observed race-sex risk differences and also examined the race-sex differences in participants with very small non-ST-elevation myocardial infarction [NSTEMI]. They study reported a 659 total incident CHD events which included 153 events in African American men, 254 in white men, 138 in African American women, and 114 in white women. They also found that very small NSTEMI comprised 31.3 percent of nonfatal CHD events.

The article presents a study to estimate the degree of association between conventional cardiovascular risk factors such as smoking, hypertension, hypercholesterolemia and type 2 diabetes with the risk of peripheral artery disease (PAD) in men. The study included 44 985 men in the U.S. without a history of cardiovascular disease at baseline. It states that the PAD is a distinct atherosclerotic syndrome marked by stenosis or occlusion of the arteries especially of the lower extremities. It concludes that smoking, hypertension, hypercholesterolemia and type 2 diabetes accounts for the majority of risk associated with development of clinically significant PAD among men.

The article discusses a randomized trial seeking to determine the influence of increasing doses of saw palmetto fruit extract on lower urinary tract symptoms (LUTS) linked with benign prostatic hyperplasia (BPH) conducted in North America. The trial involved 369 men aged 45 years old and above who were randomly assigned to receive increasing doses of saw palmetto extract or placebo. The differences in American Urological Association Symptom Index (AUASI) score of the saw palmetto extract and placebo groups are detailed. The trial found that the effectiveness of the extract was not greater than placebo.

The article describes the case of a 66-year old male patient with an abdominal aortic aneurysm (AAA). The medical history of the patient included coronary artery disease, coronary artery bypass graft surgery and tobacco use, among others. Laboratory findings during his visits to his physician between November 2004 and November 2005 are presented. Also noted is screening for AAA, risk factors and complications.

The article focuses on a study which determined whether individuals who do not report headache compared with those who report their migraine symptoms, particularly aura, in midlife are at increased risk of late-life infarct-like lesions found on magnetic resonance imaging (MRI) without clinical symptoms consideration. A population-based study of men and women aged 33-65 years old living in Reykjavik, Iceland was used for the research. Results revealed the presence of infarct-like lesions in 39.3% of men and 24.6% in women. It was also found that individuals with midlife migraine with aura had an increased risk of late-life infarct-like lesions. It noted that there is no risk for individuals with migraine without aura and nonmigraine headache.

The article presents research assessing the relationship between serum concentration of estradiol and mortality in men with chronic heart failure (HF) and reduced left ventricular ejection fraction (LVEF). The design and setting of the observational study of 501 men with chronic HF who were administered varying amounts of estradiol is explained. The outcomes measured include serum concentrations of estradiol and androgens. Results showed that high and low concentrations of estradiol were associated with an increased mortality among men with chronic HF and reduced LVEF.

The article discusses the treatment of benign prostatic hyperplasia (BPH) with 5-α reductase inhibitors such as finasteride, specifically looking for a correlation between the use of the drug with increased occurrence of hip fracture. The use of 5-α reductase converts testosterone to dihydrotestosterone, the article states. The study included over 7,000 men using data from Kaiser Permanente Southern California. Topics include the possibility that dihydrotestosterone might play a role in bone metabolism and a case-control study of hip fracture among men.

This article presents the results on a study to see if there is an association between hemodilution and a high serum prostate-specific antigen concentration (PSA) in obese men with prostate cancer. Obesity creates many problems, one of which is testing for cancer as their increased body mass index (BMI) can make detection more difficult. In the U.S. most prostate cancer patients are diagnosed after a needle biopsy which follows the discovery of a high PSA concentration. Any factor that decreases the PSA concentration level may confuse the tests and the study found that obese men do have more blood volume and may therefore have hemodilution of the PSA.

This article presents the results of a study on community-associated methicillin-resistant Staphylococcus aureus (MRSA) which has become the most frequent cause of skin and soft tissue infections presenting in emergency rooms throughout the U.S. This study looked to describe the incidence and distribution of MRSA disease in 9 U.S. communities and to estimate the burden for the U.S. in 2005. The authors found 8987 cases of MRSA in the targeted areas during 18 months, most of which were health care-associated. The standard incident rate was 31.8 per 100,000 people but were higher in the elderly, African Americans and males. The average mortality rate in 2005 was 6.3 per 100,000 people.

This article reports on inflammatory abdominal aortic aneurysms (AAA), the most common type of aneurysm. It typically strikes older men and so cases are expected to rise dramatically in the future. Smoking is almost always present in patients with inflammatory AAA and stopping is the mandatory first step in treatment. Although inflammatory AAA is less likely to rupture than other types, if the aneurysm is large surgery is necessary and generally safe. The postoperative mortality for AAA is near 5%.

A 44-year-old White man had symptoms and radiographic signs of diffuse osteoarthritis, negative inflammatory markers and HLA-B27, and a brother with osteoarthritis, hypogonadism, and type 2 diabetes. What is the diagnosis and what would you do next? [ABSTRACT FROM AUTHOR]

An 18-year-old man who recently emigrated from India presented with fever, malaise, and anorexia for 4 days. He was afebrile with scleral icterus and a palpable liver edge; had a white blood cell count of 3.9 × 103/μL with elevations in total and direct bilirubin, alkaline phosphatase, and liver enzymes; and laboratory test results were positive for HBsAg and HBV core IgG. What is the cause of his hepatitis, and what would you do next? [ABSTRACT FROM AUTHOR]

Context The risk factors for cardiovascular disease and erectile dysfunction are similar. Objective To examine the association of erectile dysfunction and subsequent cardiovascular disease. Design, Setting, and Participants Men aged 55 years or older who were randomized to the placebo group (n = 9457) in the Prostate Cancer Prevention Trial at 221 US centers were evaluated every 3 months for cardiovascular disease and erectile dysfunction between 1994 and 2003. Proportional hazards regression models were used to evaluate the association of erectile dysfunction and cardiovascular disease. In an adjusted model, covariates included age, body mass index, blood pressure, serum lipids, diabetes, family history of myocardial infarction, race, smoking history, physical activity, and quality of life. Main Outcome Measures Erectile dysfunction and cardiovascular disease. Results Of the 9457 men randomized to placebo, 8063 (85%) had no cardiovascular disease at study entry; of these men, 3816 (47%) had erectile dysfunction at study entry. Among the 4247 men without erectile dysfunction at study entry, 2420 men (57%) reported incident erectile dysfunction after 5 years. After adjustment, incident erectile dysfunction was associated with a hazard ratio of 1.25 (95% confidence interval [CI], 1.02-1.53; P = .04) for subsequent cardiovascular events during study follow-up. For men with either incident or prevalent erectile dysfunction, the hazard ratio was 1.45 (95% CI, 1.25-1.69; P<.001). For subsequent cardiovascular events, the unadjusted risk of an incident cardiovascular event was 0.015 per person-year among men without erectile dysfunction at study entry and was 0.024 per person-year for men with erectile dysfunction at study entry. This association was in the range of risk associated with current smoking or a family history of myocardial infarction. Conclusions Erectile dysfunction is a harbinger of cardiovascular clinical events in some men. Erectile dysfunction should prompt investigation and intervention for cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Context Obesity, diabetes mellitus, and glucose intolerance have been associated with increased pancreatic cancer risk; however, prediagnostic serum insulin concentration has not been evaluated as a predictor of this malignancy. Objective To investigate whether prediagnostic fasting glucose and insulin concentrations and insulin resistance are associated with subsequent incidence of exocrine pancreatic cancer in a cohort of male smokers. Design, Setting, and Participants A case-cohort prospective study within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (1985-1988) cohort of 29 133 male Finnish smokers ages 50 to 69 years. The study included 400 randomly sampled subcohort control participants and 169 incident pancreatic cancer cases that occurred after the fifth year of follow-up. All participants were followed up through December 2001 (up to 16.7 years of follow-up). Main Outcome Measures Incident exocrine pancreatic cancer identified from the Finnish Cancer Registry. Results After adjusting for age, smoking, and body mass index, higher baseline fasting serum concentrations of glucose, insulin, and insulin resistance were positively associated with pancreatic cancer. The presence of biochemically defined diabetes mellitus (glucose, ≥126 mg/dL [≥6.99 mmol/L]) and insulin concentration in the highest vs lowest quartile both showed a significant 2-fold increased risk (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.04-4.35; and HR, 2.01; 95% CI, 1.03-3.93; respectively). There were significant interactions for all the biomarker exposures by follow-up time, such that the positive associations were stronger among the cases that occurred more than 10 years after baseline (highest vs lowest quartile: glucose, HR, 2.16; 95% CI, 1.05-4.42; P for trend = .02; insulin, HR, 2.90; 95% CI, 1.22-6.92; P for trend = .005; and insulin resistance, HR, 2.71; 95% CI, 1.19-6.18; P for trend = .006). Conclusions These results support the hypothesis that exposure to higher insulin concentrations and insulin resistance predicts the risk of exocrine pancreatic cancer. [ABSTRACT FROM AUTHOR]

Context Clinically localized prostate cancer is very prevalent among US men, but recurrence after treatment with conventional radiation therapy is common. Objective To evaluate the hypothesis that increasing the radiation dose delivered to men with clinically localized prostate cancer improves disease outcome. Design, Setting, and Patients Randomized controlled trial of 393 patients with stage T1b through T2b prostate cancer and prostate-specific antigen (PSA) levels less than 15 ng/mL randomized between January 1996 and December 1999 and treated at 2 US academic institutions. Median age was 67 years and median PSA level was 6.3 ng/mL. Median follow-up was 5.5 (range, 1.2-8.2) years. Intervention Patients were randomized to receive external beam radiation to a total dose of either 70.2 Gy (conventional dose) or 79.2 Gy (high dose). This was delivered using a combination of conformal photon and proton beams. Main Outcome Measure Increasing PSA level (ie, biochemical failure) 5 years after treatment. Results The proportions of men free from biochemical failure at 5 years were 61.4% (95% confidence interval, 54.6%-68.3%) for conventional-dose and 80.4% (95% confidence interval, 74.7%-86.1%) for high-dose therapy (P<.001), a 49% reduction in the risk of failure. The advantage to high-dose therapy was observed in both the low-risk and the higher-risk subgroups (risk reduction, 51% [P<.001] and 44% [P = .03], respectively). There has been no significant difference in overall survival rates between the treatment groups. Only 1% of patients receiving conventional-dose and 2% receiving high-dose radiation experienced acute urinary or rectal morbidity of Radiation Therapy Oncology Group (RTOG) grade 3 or greater. So far, only 2% and 1%, respectively, have experienced late morbidity of RTOG grade 3 or greater. Conclusions Men with clinically localized prostate cancer have a lower risk of biochemical failure if they receive high-dose rather than conventional-dose conformal radiation. This advantage was achieved without any associated increase in RTOG grade 3 acute or late urinary or rectal morbidity. [ABSTRACT FROM AUTHOR]

Context: Studies comparing outcomes of cardiac care in women vs men yield various results, with some suggesting worse outcomes for women and others suggesting equivalent outcomes. Objective: To determine whether extent of coronary disease, treatment strategy, and follow-up time influence the risk of death in women vs men among patients who have had cardiac catheterization. Design, Setting, and Patients: We studied a large inception cohort by using detailed clinical data from a registry of 37 401 patients undergoing cardiac catheterization in Alberta, Canada, from 1995-2000, with follow-up through December 31, 2001. Main Outcome Measures: The risk of death for women vs men was assessed for all patients combined and then in analyses stratified by degree of coronary anatomic risk and by treatment strategy (no revascularization, percutaneous coronary intervention [PCI], coronary artery bypass graft [CABG] surgery). The latter analysis included a graphic assessment of the changing relative risk over time for women vs men. Results: Women had higher 1-year mortality than men did (5.6% vs 4.6%; P<.001). However, stratified analyses demonstrated that sex differences in risk occurred only early after catheterization and were most apparent among patients undergoing revascularization. The early risk-adjusted relative risks for women vs men were elevated at 3.49 (95% confidence interval [CI], 1.95-6.24) for CABG surgery and 2.38 (95% CI, 1.48-3.83) for PCI on day 1 after catheterization, with a subsequent decrease in relative risk over time to equivalence in risk between sexes before 1 year. Conclusions: Sex-based differences in death rates after cardiac catheterization are time- and treatment-specific. This finding may at least partially explain the discrepancies in results from earlier studies on sex differences in outcomes of cardiac care. [ABSTRACT FROM AUTHOR]

Looks at a study from the Centers for Disease Control and Prevention which compared the prevalence of heart disease and stroke among adults with and without diabetes. How the study was conducted; Findings that adults with diabetes were significantly more likely to report a history of CHD than nondiabetics; Diabetics who were also found to be more likely to suffer a stroke; Finding that the rates were higher in men than women; Tendency of white males to show signs of CHD; Stroke rates which were highest in non-Hispanic blacks.

Editorial. Considers how the measurement of the level of prostate-specific antigen (PSA) in the blood has had a profound impact on the management of prostate cancer. Reference to study in the same issue by Pound et al on treating a rising PSA level; How study was conducted; Implication of the findings for treatment of patients with prostate cancer.

Context: Prostate-specific antigen (PSA) evaluation leads to the early detection of both prostate cancer and recurrences following primary treatment. Prostate-specific antigen outcome information on patients 5 or more years following treatment is limited and available mainly as single-institution reports.Objectives: To assess the likelihood and durability of tumor control using PSA evaluation 5 or more years after radical external beam radiation therapy and to identify pretreatment prognostic factors in men with early prostate cancer treated since 1988, the PSA era.Design and Setting: Retrospective, nonrandomized, multi-institutional pooled analysis of patients treated with external beam radiation therapy alone between 1988 and 1995 at 6 US medical centers. Follow-up lasted up to a maximum of 9 years. Outcome data were analyzed using Cox regression and recursive partitioning techniques.Patients: A total of 1765 men with stage T1b, T1c, and T2 tumors treated between 1988 and 1995 with external beam radiation. The majority (58%) of patients were older than 70 years and 24.2% had initial PSA values of 20 ng/mL or higher. A minimum of 2 years of subsequent follow-up was required for participation.Main Outcome Measure: Actuarial estimates of freedom from biochemical failure.Results: The 5-year estimates of overall survival, disease-specific survival, and the freedom from biochemical failure are 85.0% (95% confidence interval [CI], 82.5%-87.6%), 95.1% (95% CI, 94.0%-96.2%), and 65.8% (95% CI, 62.8%-68.0%), respectively. The PSA failure-free rates 5 and 7 years after treatment for patients presenting with a PSA of less than 10 ng/mL were 77.8% (95% CI, 74.5%-81.3%), and 72.9% (95% CI, 67.9%-78.2%). Recursive partitioning analysis of initial PSA level, palpation stage, and the Gleason score groupings yielded 4 separate prognostic groups: group 1, included patients with a PSA level of less than 9.2 ng/mL; group 2, PSA level of at least 9.2 but less than 19.7 ng/mL; group 3, PSA level at least 19.7 ng/mL and a Gleason score of 2 to 6; and group 4, PSA level of at least 19.7 ng/mL and a Gleason score of 7 to 10. The estimated rates of survival free of biochemical failure at 5 years are 81 % for group 1, 69% for group 2, 47% for group 3, and 29% for group 4. Of the 302 patients followed up beyond 5 years who were free of biochemical disease, 5.0% relapsed from the fifth to the eighth year.Conclusions: Estimated PSA control rates in this pooled analysis are similar to those of single institutions. These rates indicate the probability of success for subsets of patients with tumors of several prognostic category groupings. These results represent a multi-institutional benchmark for evidence-based counseling of prostate cancer patients about radiation treatment. [ABSTRACT FROM AUTHOR]

Presents a study to characterize the time course of disease progress in men with biochemical recurrence after radical prostatectomy. Design; Setting; Patients; Main outcome measures; Results; Conclusions.

Context: The recent increase in ability to diagnose prostatic adenocarcinoma has created a dilemma for treatment decisions.Objective: To determine whether prostate cancer progression is associated with a modified version of the Gleason grading system together with selected morphologic and clinical variables.Design: Retrospective analysis of a cohort of patients with peripheral zone prostate cancers who underwent surgery between August 1983 and July 1992.Setting: University hospital.Patients: Radical prostatectomy specimens from 379 men treated only by surgical excision were prospectively studied for 8 morphologic variables using previously standardized techniques. Variables were percentage of each cancer occupied by Gleason grade 4/5 (% Gleason grade 4/5, the Stanford modified Gleason scale), cancer volume, vascular invasion, lymph node involvement, seminal vesicle invasion, capsular penetration, positive surgical margin, prostate weight, and preoperative prostate-specific antigen (PSA) level.Main Outcome Measure: Biochemical progression of prostate cancer as indicated by serum PSA level of 0.07 ng/mL and increasing.Results: Cancer grade expressed as % Gleason grade 4/5 and cancer volume were highly predictive of disease progression. In a Cox proportional hazards model that included % Gleason grade 4/5, the traditional Gleason score was not an independent predictor of treatment failure. Positive lymph node findings and intraprostatic vascular invasion were the only other variables that remained significant at the .01 level.Conclusion: The % Gleason grade 4/5, cancer volume, positive lymph node findings, and intraprostatic vascular invasion were independently associated with prostate cancer progression, defined by an increasing PSA level. Techniques to accurately measure cancer volume and % Gleason grade 4/5 are needed to better predict which patient will experience cancer progression. The commonly accepted predictors of progression-capsular penetration and positive surgical margins-were not independently predictive of failure after radical prostatectomy. [ABSTRACT FROM AUTHOR]

Presents the case of a 41-year-old man with HIV. His understanding and perceptions; Care of people with HIV infection; Preventing progression of immunodysfunction in asymptomatic individuals; Living with HIV and AIDS; Evolving models of HIV care; Questions and discussion.

Presents a study which examined whether carotid endarterectomy provide protection against subsequent cerebral ischemia in men with ischemic symptoms. Factor which led to the widespread use of carotid endarterectomy to prevent stroke; Definitions of treatment failure; Association between stroke risk and carotid stenosis.

Presents a study that assessed the concordance of dyslipidemic hypertension among male twins in the U.S. Association of hypertension with lipid values; Analysis of the lipid abnormalities among the male twins; Relation of ischemic heart disease among twins with dyslipidemic hypertension.

Considers how the appropriate therapy for men with localized prostate cancer is uncertain. Study to estimate survival based on a competing risk analysis stratified by age at diagnosis and histologic findings for men diagnosed as having clinically localized prostate cancer and who were managed conservatively; Design; Setting; Patients; Main outcome measures; Results; Conclusions.

Presents information on a study which compared regimens of ciproflaxin with doxycycline for the treatment of nongonococcal urethritis in men enrolled in a prospective, randomized and double-blind trial. Patient enrollment; Evaluation of treatment response; Response of nongonococcal urethritis to treatment; Patient characteristics; Treatment response by microbiologic findings at enrollment.

A 67-year-old man with type 2 diabetes, unintentional weight loss, and increasing fasting blood glucose levels showed diffuse enlargement of the pancreas with peripheral hypoenhancement but no discrete mass on CT scan and soft tissue surrounding the abdominal arteries and left ureter causing hydronephrosis. Testing showed no pancreatic malignancy, no abnormal findings on colonoscopy, and lab results showed elevated IgG4. How would you interpret the test results? [ABSTRACT FROM AUTHOR]

Presents an editorial regarding radiation dose escalation as a treatment for clinically localized prostate cancer. Management of clinically localized adenocarcinoma of the prostate; Risk of disease recurrence following therapy; Description of advances in radiotherapy techniques; Reference to a study conducted by Zietman and colleagues, found in the September 14, 2005 issue, regarding proton-beam radiation; Claim that men with localized prostate cancer do benefit from increased radiation dose delivered to the prostate as evidenced by an increase in freedom from disease recurrence; Risks associated with higher radiation doses.

Focuses on debate over screening for prostate cancer. Observations of proponents of screening including Dr. William Catalona; Potential danger of screening discussed by Dr. Gerald Chodak; Organizations including the American Cancer Society and the American Urological Association which no longer endorse screening; Views of Dr. Otis Brawley of the United States National Cancer Institute.

Editorial. References two studies in the same issue by Albertsen et al and D'Amico et al that examine treatments for prostate cancer. Various treatment options; Mortality risk factors; Need for physicians to exercise a good amount of caution about recommending treatments that lack definitive long-term survival results.

Describes patients who were noted to have unilateral absence of the vas deferens during routine physical examination and who were examined for the presence of an ipsilateral renal unit. Association of the absence of the vas deferens with agenesis; Contralateral abnormalities that occurred in the patients; Examination for the presence of the ipsilateral renal unit.

The article presents the case of a 32-year-old male who was rushed to a medical facility with a one month history of swelling and pain over his nose. He has a history of type 1 diabetes mellitus, hypertension, stage 3 chronic kidney disease, and chronic hepatitis C. He was diagnosed with blastomycosis and was treated with broad-spectrum antibiotics and underwent operation for debridement.

The authors discuss rates of bisphosphonate prescriptions in prostate cancer patients in Ontario who underwent androgen deprivation therapy (ADT) between 1995 and 2012. Topics addressed include side effects such as bone loss and higher fracture risk, indications of limited awareness among clinicians regarding optimal bone health management, and factors contributing to lower biphosphonate prescriptions after 2009. Also mentioned are biophosphonate prescriptions in those with prior osteoporosis.

IMPORTANCE Relatively little is known about the prevalence of concerns with physique and eating disorders among males and their relation to subsequent adverse outcomes. A broader range of eating disorders needs to be defined to diagnose these illnesses appropriately in males. OBJECTIVE To investigate whether males with psychiatric symptoms related to disordered eating and concern about physique are more likely to become obese, to start using drugs, to consume alcohol frequently (binge drinking), or to develop high levels of depressive symptoms. DESIGN, SETTING, AND PARTICIPANTS The data come from questionnaires sent every 12 to 36 months from 1999 through 2010 to youth in a prospective cohort study, the Growing Up Today Study. The analysis included 5527 males aged 12 to 18 years in 1999 from across the United States who responded to the Growing Up Today Study questionnaires. MAIN OUTCOMES AND MEASURES Development of obesity and high levels of depressive symptoms and initiation of drug use and binge drinking at least monthly. RESULTS From 1999 through 2011 in at least 1 study year, 9.2% of respondents reported high concerns with muscularity but no bulimic behaviors; 2.4%, high concerns with muscularity and use of supplements, growth hormone derivatives, or anabolic steroids to achieve their desired physique; 2.5%, high concerns with thinness but no bulimic behaviors; and 6.3%, high concerns with thinness and muscularity. For eating disorders, 0.8% had partial- or full-criteria bulimia nervosa or purging disorder and 2.9% had partial- or full-criteria binge eating disorder but no association with the outcomes of interest. Infrequent binge eating or purging or overeating without a loss of control were reported by 31.0%. However, independent of age and body mass index, males with high concerns about thinness but not muscularity were more likely to develop high depressive symptoms (odds ratio, 2.72; 95%CI, 1.36-5.44). Males with high concerns about muscularity and thinness were more likely than their peers to use drugs (odds ratio, 2.13; 95%CI, 1.31-3.46), and males with high concerns about muscularity who used supplements and other products to enhance physique were more likely to start binge drinking frequently (2.06; 1.58-2.69) and using drugs (2.16; 1.49-3.11). CONCLUSIONS AND RELEVANCE High concerns with muscularity are relatively common among adolescent boys and young men. Males with these concerns who use potentially unhealthy products to improve their physique are at increased risk of adverse outcomes but may not be recognized by their health care providers as having a weight-related disorder because of the sex-specific presentation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 45-year-old man who was brought to the hospital for follow-up of dysuria. He underwent rapid plasma regain (RPR) and Treponema pallidum enzyme immunoassay and was diagnosed with latent syphilis. The patient was administered with a single intramuscular dose of benzathine penicillin G.

The author comments on issues related to testosterone therapy and the risk of cardiovascular disease in men. According to the author, there are less data from randomized trials that include a sufficient number of men for an adequate amount of time to examine the long term benefits and risks of testosterone therapy. She discusses a retrospective analysis from the Veterans Affairs system of men who have undergone coronary angiography and had subsequent total testosterone assessment.

The article states that men are more likely to suffer from mental illnesses, particularly mental depression, without seeking health care services because they exhibit different symptoms than women, are less likely to recognize that they have a mental health disorder, and are more reluctant to seek help. The demographic group most likely to commit suicide is older men. Some men view receiving medical care for a mental illness as "unmanly." Depression can be treated by medicine and cognitive behavioral therapy. INSET: Depression in Men.

Reports on studies which compared the incidence of heart diseases in men and women. Role of female hormones in lipoprotein metabolism and atherosclerosis; Effects of progesterone; Explanation on why heart attacks are more often fatal to women than to men.

A continuing medical education (CME) quiz is presented on the use of advanced treatment technologies among men at low risk of dying from prostate cancer.

A quiz concerning the association between conventional cardiovascular risk factors and risk of peripheral artery disease in men is presented.

The article references a study by A. R. Guiliano and colleagues, published in a 2011 issue of "Lancet," which shows that about 50 percent of men in the general population are infected with genital human papillomavirus (HPV) and that vaccinating boys against the virus is recommended.

The article discusses research on the risk of HIV transmission on circumcised men and on women. It references a study by M. J. Waver and colleagues published in a 2009 issue of "Lancet." A total of 922 uncircumcised, HIV-infected, asymptomatic men aged 15 to 49 years old with CD4 cell counts of at least 350/µ/liter (L) were used in the study. The trial was stopped by the data and safety monitoring board after finding that a larger percentage of women in the intervention group became infected compared with the control group.

The article offers a patient page which provides information on prostate cancer. Basic information about the location and functions of the prostate gland are explained. Prostate cancer is the most common form of cancer and the second leading cause of cancer deaths among men in the U.S. The diagnostic tests for the condition including digital rectal examination and prostate-specific antigen blood tests are described. The initial treatment options including watchful waiting, prostatectomy, and radiation therapy are detailed.

The article focuses on research on prostate cancer which was performed by three independent teams of scientists from the United States and Europe. Researchers conducted genome wide association studies of thousand of individuals with and without prostate cancer and found at least ten previously unknown gene variants linked to prostate cancer susceptibility. While the researchers were unable to identify the specific genes flagged by the variants, they estimated that some genetic loci contain or are near plausible candidate genes, including KLK3, the gene that encodes prostate specific antigen.

This article offers the patient education page which discusses lymphoma. It offers an overview of the lymphatic system and how it works. An explanation of lymphoma tells of lymphocytes that become malignant and crowd out normal cells. Lymphomas are classified as either Hodgkin disease or non-Hodgkin lymphoma. The abnormal cells in the two forms are different. The symptoms of the disease are listed including unexplained fever, night sweats, constant fatigue and unexplained weight loss. Risk factors are outlined including the fact that men are more likely than women to develop the non-Hodgkin variety.

Reports on a recommendation by the US Preventive Services Task Force that men between the ages of 65 and 75 who have been or are smokers get one time ultrasound screening for abdominal aortic aneurysms. Task force which based the advice on a report from Portland which studied the value of screening; Number of deaths in the US each year from ruptured aneurysms.

Discusses a software program that can help determine which patients with prostate cancer are likely to develop a recurrence of their cancer after surgical treatment. Accuracy rate of program; Comment by Dr. Muta Issa, lead author of the study.