"Prostate Cancer: Physical Recovery"

How to Detect Prostate Problems : Late Stages of Prostate Cancer

The Importance of Early Detection of Prostate Cancer

Prostate Cancer Risk Higher in Men with Breast Cancer Gene

Results of a new study support what researchers have known for some time: there is a connection between breast cancer and prostate cancer—at least when it comes to certain genes. The new study reports that men who have the mutated breast cancer gene BRCA1 are nearly four times more likely to develop prostate cancer than men without the gene.



The BRCA1 (breast cancer 1, early onset) gene is a tumor suppressor gene, and it produces a protein that helps prevent cells from growing and dividing uncontrollably, as occurs in cancer. BRCA1 genes also provide instructions for making a protein involved in repairing damaged DNA.  Mutated BRCA1 genes carry a cancer risk and can be inherited from either parent.

Researchers from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust reported that out of 913 men who underwent prostate cancer screening, three-quarters of those who had the mutated BRCA1 gene were diagnosed with prostate cancer before age 64, indicating that having the mutated gene might be an early warning for men with a greater risk of developing the disease at a younger age.

According to Prostate Action Chief Executive Emma Malcolm, “We’ve long known about the link between breast cancer and prostate cancer and this research confirms the likelihood of men developing prostate cancer from the inherited faulty BRCA1 gene.” Early detection of men with the mutated BRCA1 gene could allow doctors to monitor them for prostate cancer from a younger age.

Genes Increase Prostate Cancer Risk Up To Fourfold

Discoveries in the realm of genetics and prostate cancer have been brisk as of late, and among the latest findings are two inherited genetic variants that can increase a man’s risk of developing prostate cancer by threefold or fourfold. The findings appeared in the online April 9 Proceedings of the National Academy of Sciences.




Among previous studies, scientists have discovered genetic markers linked to aggressive prostate cancer, and researchers at the University of Michigan Comprehensive Cancer Center even identified a prostate cancer gene called SPINK1 that occurs in aggressive forms of prostate cancer. This latest discovery adds to the growing knowledge about genetics and prostate cancer risk.

More than 1,900 blood samples from men with prostate cancer and healthy controls were examined for the study, and the scientists discovered two different genetic variants or deletions in men who had aggressive prostate cancer. One affects the functioning of a known gene, and the other appears to regulate a cascade of genes. The second gene variant was found in what is known as a “non-coding” area, which means the gene does not make proteins, and this information is significant. Why?

According to Dr. Mark A. Rubin, the Homer T. Hirst Professor of Oncology in Pathology at Weill Cornell Medical College and one of the researchers, “We used to think that only genes that made proteins were responsible for disease, but this study shows us that there is inherited information in the non-coding areas of the genome that appear to play a strong role in development of cancer.”

Protein Discovery Could Lead to New Cancer Treatment

Scientists at Lund University are on a quest to resolve a classic “if/then”  situation involving a protein discovery that could lead to new cancer treatment. Basically, if they can block a protein called gamma-tubulin, then targeted cancer cells should die while healthy cells survive.

One major problem with cancer treatment is that most chemotherapy drugs and radiation therapy not only have an effect on cancerous cells, but also damage healthy cells. This cell damage results in side effects and complications that can seriously impact a patient’s quality of life.

The Swedish investigators found that the retinoblastoma protein, which interferes with cell division, is not present in most cancer tumors. When this protein is absent, it leads to an increase in gamma-tubulin, another protein which, at elevated levels, promotes the development of cancer tumors.

That leaves the researchers with an if/then situation, and they are already searching for substances that can stop the effect of gamma-tubulin on cell division. If they find that substance, then it could be the basis for a new cancer treatment that only kills tumor cells and if targeted at the right place.

Prostate Cancer Vaccine Prostvac to Enter Phase 3 Trials

Among the latest potential prostate cancer treatments and vaccines is Prostvac, a vaccine about to enter Phase 3 trials in the United Kingdom, representing the first prostate cancer vaccine to ever reach this stage in Europe. Prostvac is currently in trials in the United States and will be entering trials in 18 other countries along with the UK.




Prostvac, which was developed by Bavarian-Nordic Immunotherapeutics for men with advanced prostate cancer that has resisted hormone therapy, is a combination of the virus used in a smallpox vaccine and a strain of a virus (fowlpox) that causes diseases in poultry. Four human genes were then added to the DNA of these viruses.

Prostvac is considered to be a vaccine because it reportedly works by using these viruses to transport the human DNA to direct the immune system to fight cancer cells. In the Phase 3 trial in the UK, researchers will enroll about 30 patients to see how Prostvac meets this challenge.

During the trial, the patients will be given a series of seven injections over a five-month period. According to Dr. Reiner Laus, president of the vaccine’s manufacturer, Prostvac has milder side effects than other treatments for prostate cancer, and the vaccine will hopefully be licensed by 2015.

Does Social Status Affect Men’s Health?

Are you climbing the corporate ladder, struggling to maintain your social status, and experiencing lots of stress as a result? A new study in monkeys suggests a link between improvement in social status and changes in gene expression involved in immune response, suggesting a change in social status may affect your health.

It’s well accepted that stress has an impact on both physical and emotional health. Much research has linked stress levels with conditions ranging from gastrointestinal disorders to depression, heart disease, stroke, hair loss, and erectile dysfunction
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Yoav Gilad, PhD, associate professor of human genetics at the University of Chicago Biological Sciences, and his team studied social ranking and stress among a population of 49 captive female rhesus macaques of different social rank. They discovered that when a female monkey’s social rank improved, her gene expression changed within a few weeks, which suggests social influences or environment can alter genes.

According to Jennifer Tung, the postdoctoral researcher who led the study, “There’s a spooky side to this kind of research, in that an individual’s social rank is partially determining health status.” Gilad also noted that the study results indicate “Whatever it is that causes stress through social environment, you might be able to fix.”

Men Skip Their 5-A-Days and Opt for Meat Because They Find Vegetables Unmanly

A new study may reveal why men are generally more reluctant to eat vegetables.

A group of researchers from the University of Pennsylvania, Louisiana State University, University of North Carolina, Chapel Hill and Cornell University found that men, particularly men from western countries, generally associated meat with masculinity and vegetables as “weak and wimpy”.

The researchers analyzed the results from a number of experiments that studied metaphors and certain foods, like meat and milk, and found that people generally rated meat as more masculine than vegetables. 
Not only do people more masculine words when talking about meat, people also perceived meat eaters as being more masculine than non-meat eaters.

The study authors also analyzed 23 different languages with gendered pronouns and found that meat was related to the male gender in most languages.


"To the strong, traditional, macho, bicep-flexing, All-American male, red meat is a strong, traditional, macho, bicep-flexing, All-American food," the study authors reported in the Journal of Consumer Research. "Soy is not. To eat it, they would have to give up a food they saw as strong and powerful like themselves for a food they saw as weak and wimpy."

Researchers say that marketers and health advocates need to address the metaphors that shape consumer attitudes and lessen such powerful associations that can lead consumers to make bad health decisions, like opting for meat over vegetables. 

For instance, reshaping soy burgers to look more like beef patties by giving them grill marks, may help men reluctant to eat food other than meat make the transition compared to an education campaign that encourages people to eat more vegetables.

"In marketing, understanding the metaphor a consumer might have for a brand could move the art of positioning toward more of a science," the authors conclude.

Unfaithful Men Are More Likely to Have Heart Attacks

Men who cheat on their wives are more likely to suffer "sudden coital death" when meeting with his lover outside of his home than when he was with his wife, according to Italian researchers.

A review of previous studies, published in The Journal of Sexual Medicine, shows that unfaithful men risk not only their marriage but also their cardiac health, and sexual encounters away from home and with younger women are particularly dangerous.


The precise reasons for the increase in heart attack death are still unclear, but researchers suggest that a guilty conscience, stress from keeping the affair a secret, and the stress of wining, dining and satisfying a woman who is likely to be younger than the man’s wife could all contribute to the link.

Using key terms such as 'unfaithfulness', 'extramarital affairs', 'infidelity' and 'men', University of Florence researchers analyzed the frequency and context of heart attacks in men and revealed that both fatal and non-fatal heart attacks were relatively rare when a man had sex with his wife, but significantly more frequent when he was with a mistress.

In the past German scientists found that most men who died while having sex were cheating and meeting outside of their family home.




Researchers suggested that blocked up arteries were responsible for more than a third of the deaths because the physical demands of sex are said to cause fatty plaque that has accumulated in the arteries to rupture.
Heart attacks were the next biggest cause of death in men who died while having sex.

"Extra-marital sex may be hazardous and stressful because the lover is often younger than the primary partner and probably sex occurs more often following excessive drinking and/or eating," Researcher Dr. Alessandra Fisher said in the study.

"It is possible that a secret sexual encounter in an unfamiliar setting may significantly increase blood pressure and heart rate, leading to increased oxygen demand," she added.

Researchers said that a guilty conscience may also be why heart problems are more common among adulterers who are still have feelings for their wives.

"Betraying this partner could punish him," said Fisher.

About 4 percent of married men have an affair every year, and over a man’s lifetime, there is a 50 percent chance of him cheating, researchers suggest.

Researchers revealed that parenthood, conflicts within the family and a dysfunctional primary relationship were all associated with a higher risk of having an affair.

Cheating men were also found to have higher levels of male hormones, larger testicle size, greater sexual desire, and better sexual functioning.

"Only few studies have evaluated the correlation between infidelity and cardiovascular risk, reporting that having an extramarital affair could have a negative impact on cardiac morbidity and mortality," the authors wrote.

"Definitions of unfaithfulness and its consequences vary across different cultures, religions, and legal jurisdictions; however, having extramarital affairs is associated in most societies with a stigma. Therefore, the study of this sensitive topic is extremely complex, and its prevalence is often underestimated," they said.

Men eating more salt than women!

New figures from the Department of Health show the nation's average salt intake is continuing to decrease slowly - with women consuming significantly less salt than men.

Survey results reveal the mean estimated salt intake for adults aged 19 to 64 years was 8.1g per day. The findings showed the intake for men was 9.3g per day, while for women it was 6.8g. The Department of Health calculated the figures by measuring the amount of sodium in the urine of more than 500 people.

It's recommended that adults consume no more than 6g of salt a day but in 2000/01 the mean estimated salt intake stood at 9.5g. In 2008, the figure was 8.6g.

Victoria Taylor, Senior Dietitian at the British Heart Foundation, said: "It's good news that salt intakes appear to be slowly falling but there is still some way to go.

"Reformulation of foods has helped to reduce salt in our diets but it's vital this work continues across the food industry so we can make further progress towards the national target of no more than 6g of salt a day.

"What is also interesting is that men are lagging behind when it comes to salt intake. We know women take advantage of food labels which could be helping them avoid salty foods, but it looks like men might need more help in the supermarket. Clear and consistent front-of-pack labels, with traffic light colours, will help us all to make healthier choices."

Men has better eyesights than women?

Studies have consistently reported that women require reading glasses or bifocal lenses earlier than men. According to a recent Investigative Ophthalmology & Visual Science paper, the gender difference is caused by factors other than focusing ability, such as arm length or preferred reading distance, which should be considered when prescribing readers or bifocals.

The new evidence was found by a team of researchers who performed a meta-analysis using nine cross-sectional studies to compare the prevalence and magnitude of presbyopia - commonly described as the loss of near vision that occurs with age - among men and women. The researchers further subdivided the analysis to determine what differences in presbyopia might exist between men and women.

The new evidence was found by a team of researchers who performed a meta-analysis using nine cross-sectional studies to compare the prevalence and magnitude of presbyopia - commonly described as the loss of near vision that occurs with age - among men and women. The researchers further subdivided the analysis to determine what differences in presbyopia might exist between men and women.

While the results of a subgroup of studies showed that there was no significant gender-related difference in the eye's ability to focus clearly on objects at near distances, the overall analysis provided evidence that women have a need for higher power reading glasses or bifocals than men of an equivalent age. According to the researchers, this discrepancy is likely due to differences in preferred reading distances or arm length as women tend to hold reading materials closer than men do.

"These findings could impact global vision care in multiple ways," said Hickenbotham. "The findings reinforce the need for presbyopia correction programs for women - a group that often has greater unmet vision needs in developing countries. It also points out that presbyopia is a multi-factorial problem and requires solutions that are tailored to each individual."

While the researchers urge clinicians to do more than measure the eye's ability to focus when diagnosing presbyopia, they also suggest more carefully performed studies be conducted that better isolate and measure the various factors that contribute to its development. In particular, the paper states longitudinal studies that consider the interaction between the preferred reading distance and the change in accommodative amplitude across time for males and females could help determine to what extent biological factors or environmental factors plays a role in the loss of focusing ability with increasing age.

Provenge: A Different Kind of Prostate Cancer Treatment

Provenge® (sipuleucel-T) is a unique treatment option for men who have asymptomatic or minimally symptomatic prostate cancer that has spread (metastasized) and also resisted hormone therapy (also referred to as metastatic castrate resistant or hormone refractory prostate cancer). Before the introduction of Provenge, men with this type of prostate cancer had no promising treatment opportunities.
Studies show that hormone resistant prostate cancer progresses rapidly, therefore prompt treatment is critical. In fact, up to 80% of men with hormone resistant prostate cancer develop metastases, and 46% of men with this form of the disease develop metastases in only two years. (Smith 2005; 2011)

What is Provenge?

Provenge is unlike other prostate cancer treatments because it is a form of immunotherapy, which means it is designed to utilize and work with a man’s immune system to fight prostate cancer. In this sense, Provenge is sometimes referred to as a prostate cancer vaccine, because  vaccines are also a form of immunotherapy. However, unlike a true vaccine, Provenge cannot provide immunity against disease.
Provenge is an autologous cellular immunotherapy, which means it uses a man’s own immune cells (autologous) to battle prostate cancer. To accomplish this, a series of carefully orchestrated steps must be followed, with the end result being a drug that is personalized for each patient. Those steps are explained below (“How Provenge Treatment Works”).

How Provenge Differs From Other Prostate Cancer Treatments

The main reason Provenge differs from other treatments for prostate cancer is that it is the only prostate cancer immunotherapy approved by the Food and Drug Administration (FDA) and the first in a new class of therapy to use this approach. Another way to look at Provenge versus other prostate cancer treatments is that while other therapies work against the body–chemotherapy and radiation therapy are toxic and focus on killing cancer cells, while hormone therapy stops production of hormones–Provenge is a positive approach that makes use of the body’s own immune cells (T-cells) which have been activated in a laboratory so they can recognize and battle prostate cancer cells.

Who Can Take Provenge

Dendreon Corporation, makers of Provenge, and The National Comprehensive Care Network recommend Provenge as a first-line treatment for men who meet the following criteria. Let’s take each factor individually.

• Asymptomatic or minimally symptomatic prostate cancer. This means a man has no cancer pain or if cancer pain is present, it is not severe enough to require treatment with narcotics.
• Cancer has metastasized. The prostate cancer has spread beyond the source tumor in the prostate to other areas of the body, such as the bones.
• Resistant to hormone therapy. The patient’s prostate cancer has worsened since undergoing treatment with drugs that stop the production of hormones.

Your healthcare provider can determine if you meet the criteria for treatment with Provenge. Physicians take several other factors under consideration when deciding if a patient is a candidate for Provenge. For example, men who have a lower tumor burden and an otherwise healthy immune system are positive candidates for Provenge. Physicians may also recommend Provenge so men can take advantage of immunotherapy before their disease progresses too far and they are no longer a candidate for treatment with Provenge.

How Provenge Treatment is Prepared

If your healthcare provider decides you are a candidate for Provenge, he or she will not write a prescription and send you off to a pharmacy to fill it. Instead, each dose of Provenge is unique and tailor made for you. Therefore, a series of steps are necessary to create each personalized dose of Provenge using your own blood cells. Here is how the process works.

• Your doctor will order a complete blood count to check your blood cell levels.
• To make your personalized dose, you must undergo a process called leukapheresis, which involves having your blood drawn either through a vein or through a central venous catheter placed into a large vein near the heart. The blood flows through a tube to a machine where immune cells, platelets, and some red blood cells are collected from the blood sample. The machine then returns the rest of the cells and the blood to the body. This entire process is an outpatient procedure and takes about 3 to 4 hours to complete. You can read, rest, listen to music, or watch a movie during the procedure.
• The collected immune cells are sent to a facility where they are activated with a recombinant antigen, which is designed to prompt the immune cells (T-cells) to look for and attack prostate cancer cells. Within 2 to 3 days, the completed personalized dose is then shipped to your doctor or infusion location.
• The activated immune cells–your personalized Provenge dose–is given by infusion within about three days of the leukapheresis procedure. The infusion process takes about 2 hours: 1/2 hour before the infusion, you will be given acetaminophen or an antihistamine to help reduce the possibility of side effects associated with the infusion. After the one-hour infusion, you will be observed to be sure there are no adverse reactions to treatment.
• Treatment with Provenge involves three infusions, so you must undergo a second leukapheresis procedure two weeks after the first one, and then a third leukaphersis two weeks after the second one. Each leukapheresis is followed by infusion of the personalized dose of Provenge within three days of the collection process.

To recap: A treatment course with Provenge involves three leukapheresis procedures, each of which is followed within 3 days by an infusion of Provenge. The entire treatment course takes 5 weeks. Because each personalized dose of Provenge has a short shelf life, men who miss an infusion appointment will need to undergo another leukapheresis so clinicians can prepare another dose of Provenge.

How to Prepare for Provenge Treatment

If you and your doctor have decided you will undergo Provenge treatment, be sure to tell your healthcare provider about any medical problems you have, including heart problems, lung disorders, and any history of stroke. Also tell him or her about any medications (both prescription and over-the-counter), vitamins, and other supplements you use.
To prepare for the leukapheresis procedure, it is helpful to follow these tips:

• Drink more water than you normally do to stay well hydrated
• Do not drink any caffeinated beverages on the day of your leukapheresis procedures
• Wear comfortable clothing, including sleeves that can be easily raised above the elbow
• Eat a breakfast that contains calcium-rich foods, such as almonds, blueberries, bananas, yogurt, and calcium-enriched orange juice or cereal
• Ask someone to drive you home after the procedure. Many men feel fatigued after leukapheresis.

How Provenge Affects PSA

Doctors typically use the prostate-specific antigen (PSA) test to monitor the progression of prostate cancer and the effects of treatment. Men who take Provenge should know that even if they do not see an improvement in PSA levels, this does not mean Provenge is not working. Provenge can be effective regardless of any changes reflected in PSA levels.

Benefits of Provenge

The goal and primary benefit of Provenge treatment is to help men with prostate cancer live longer. In a clinical study involving 512 men, Provenge reduced the risk of death in men by 22.5%. More specifically, the median survival for the 341 men who took Provenge was 4.1 months longer than that of the 171 men in the placebo group (25.8 months compared with 21.7 months). (Kantoff) In addition, data from Dendreon Corporation note that at three years, 37.8% more patients treated with Provenge were alive when compared with controls. (Dendron)
Another benefit of Provenge treatment is that men who use Provenge can then go on to use other prostate cancer therapies. In fact, because Provenge stimulates the immune system, men who undergo this immunotherapy are often in better condition to handle immunosuppressive therapies, such as chemotherapy.

Side Effects of Provenge

The most common side effects of Provenge treatment, occurring in at least 15% of patients, are back pain, chills, fatigue, fever, headache, joint ache, and nausea. Side effects are generally not severe enough to cause men to stop treatment. In one study, less than 1.5% of men who took Provenge stopped treatment because of side effects.
Infrequently, Provenge can cause serious reactions, including stroke or severe infusion reactions within one day of infusion, which have been shown in 3.5% of patients. Severe infusion reactions may include breathing problems (reduced oxygen level, shortness of breath, wheezing), chills, dizziness, fatigue, fever, headache, high blood pressure, muscle ache, nausea, vomiting, and weakness.
Men who take Provenge should contact their doctor if they experience any of the mentioned side effects as well as any symptoms not listed that concern them.

Curcumin or Turmeric Is Good For Men’s Health

Many studies have reported that curcumin, the key ingredient in the spice turmeric, is beneficial for your health, but why they can make this claim has not been determined. Now scientists at Oregon State University (OSU) have identified a reason why curcumin is good for you.

Turmeric has been an integral part of Ayurvedic medicine and various other healing practices for millennia because of its anti-inflammatory and antioxidant properties. In recent years, numerous studies have shown curcumin to be helpful in the management of a variety of health concerns, ranging from prostatitis and prostate cancer to arthritis and heartburn.

A secret of curcumin’s healing abilities appears to be its ability to increase the levels of a protein called cathelicidin antimicrobial peptide (CAMP), which has a key role in the immune system that helps prevent infection. This discovery was uncovered by researchers in the Linus Pauling Institute at OSU, who collaborated with scientists from the University of Copenhagen.

Specifically, the researchers found that curcumin increased expression of the CAMP gene by nearly threefold, and thus could be helpful in preventing infection. Vitamin D also has the ability to boost expression of the CAMP gene, and it is more potent than curcumin in this regard.

Brachytherapy for Prostate Cancer Effective as Surgery

Would you try a brachytherapy treatment for prostate cancer that took only about 30 minutes and was just as effective as surgery? Some men already have at the hands of British surgeons who developed the technique at the Royal Surrey County Hospital in Guildford.

The 30 minute treatment for prostate cancer is an advanced form of brachytherapy, a type of radiation therapy that involves implanting either permanent radioactive capsules (seeds) or temporary needles into a cancerous site. Brachytherapy is considered a treatment option for men who have small tumors that are confined to the prostate.

While conventional brachytherapy typically takes about 3 hours to complete, the new form can be completed in as little as 30 minutes and be just as effective as the conventional approach. According to the surgeons who developed the new brachytherapy, a two-minute scan of the patient’s prostate identifies how many seeds should be implanted and where they should be placed. The surgeons than implant up to 120 seeds in an operation that takes 30 to 40 minutes.

Men who have undergone this new type of brachytherapy have typically been discharged from the hospital the same day and return to work within 48 hours. The investigators report that this form of brachytherapy is just as effective as surgery but is less expensive and has fewer side effects. For example, while many men need help with erectile dysfunction after conventional brachytherapy, about 83 percent of men maintained erectile function after undergoing the new form of brachytherapy.

Provenge vs Zytiga for Prostate Cancer

he pharmaceutical industry is a highly competitive field, and the players come out of their corners fighting full force when the stakes are high. Currently, two competitors in the arena for the metastatic hormone resistant prostate cancer market are Provenge (sipuleucel-T) and Zytiga (abiraterone), but the competitors are not evenly matched.
First of all, the two drugs are not in the same drug class: Provenge, made by Dendreon, is a form of immunotherapy, and it is the only drug for advanced prostate cancer that can make this claim. It is sometimes referred to as a vaccine for treatment of prostate cancer and is also the only immunotherapy drug approved by the Food and Drug Administration (FDA) for treatment of advanced prostate cancer.
Zytiga also has a unique quality in that it is the only hormone therapy drug that stops hormone production in three sites: the testes, adrenal glands, and the prostate tumor itself. Other hormone therapies for prostate cancer are capable of interfering with hormone production in the first two mentioned sites only.
The maker of Zytiga (Johnson & Johnson) recently announced that it was stopping its latest drug trial because the drug had (1) demonstrated good control of prostate-specific antigen (PSA) levels (which is an indicator of disease progression), and (2) shown a trend for an overall survival benefit. While the first factor is significant, the second is not because the trial results did not demonstrate a statistically significant improvement in overall survival, which was one of the two main endpoints of the study.
Why is this important? Because J&J indicated that the Zytiga trial had been a success, yet according to the rules regarding medical trials, all defined endpoints–regardless of how many there are–must be statistically significant before a trial can be deemed a success.
That’s not to say that Zytiga is not an effective drug for treatment of late-stage prostate cancer –that remains to be determined. However, it appears the drug was not given a full opportunity to prove itself in this latest trial.
Provenge, on the other hand, was recently shown to meet its study endpoint (overall survival). The clinical trial involved 512 men, and the median survival for the 341 men who took Provenge was 4.1 months longer than that of the 171 men who were in the placebo group.
More specifically, men in the Provenge group lived a median of 25.8 months compared with 21.7 months in the control group. Furthermore, at three years, 37.8% more men treated with Provenge were alive when compared with men in the control group.
Overall, when the results of the Provenge trial are compared with those of the Zytiga trial, we find that:

• Provenge showed a statistically significant benefit in overall survival that also improved over time
• The benefit in overall survival seen with Provenge was clear at six months after treatment
• Zytiga did not show a benefit in overall survival until 18 months after the men started treatment. By that time, 20% of the men being treated had died, before any possible survival benefit was apparent

Other benefits of Provenge over Zytiga include:

• Provenge requires three doses given over 4 to 5 weeks and then the treatment is done
• Zytiga must be taken daily, along with a steroid (prednisone), for an average of eight months. Steroids weaken the immune system, which places the patient at increased risk of infection, while Provenge works with the immune system
• Because men who wish to take Provenge must be free of steroid use (a “steroid wash out waiting period) before they begin treatment, men who have already used Zytiga and who then want to try Provenge must go through this wash out period before they can start Provenge. Given the importance of treating men who have metastatic hormone resistant prostate cancer as promptly and effectively as possible, this wash out period could prove deadly for some men. In addition, men are eligible for Provenge only if their disease is asymptomatic or minimally symptomatic. Men who need to wait throughout a steroid wash out period are likely to progress past this stage of disease, making them ineligible for Provenge.

Men who have metastatic hormone resistant prostate cancer need to educate themselves about their treatment options and discuss them thoroughly with their healthcare providers before making a treatment decision.

Heavy may help men with one type of cancer?

Extra weight may not be good for your health in general, but heavy men appear more likely to survive a particular form of immune system cancer, according to a U.S. study.

The study, published in the Journal of Clinical Oncology, concerned an aggressive form of non-Hodgkin lymphoma called diffuse large B-cell lymphoma (DLBCL).
Non-Hodgkin lymphomas include a large group of cancers that affect the lymphatic system, a part of the immune system, and DLBCL is the most common form.

Some research has linked obesity to a greater risk of developing DLBCL. In certain other cancers - like breast and colon cancers - obese patients might also have a worse prognosis than those who are thinner when they are diagnosed.

"We expected something similar when we started this project," said Kenneth Carson of Washington University School of Medicine in St. Louis, the lead researcher.
What they actually found came as a surprise.

Of more than 2,500 U.S. veterans with the cancer, men who were obese at diagnosis had only about two-thirds the risk of dying during the study period that normal-weight men had, after considering other factors like age and overall health.

Out of 625 obese men, 294 - or 47 percent - died over the next five years. That compared with 64 percent of 849 men who were normal weight when diagnoses.

Men who were not obese, but overweight, also had a better prognosis than their normal-weight counterparts, a 27 percent lower death risk during the study period.

It's not clear exactly why heavy men with the lymphoma would survive longer, and Carson stressed that the findings don't mean that men should allow themselves to gain or hang on to excess weight.

But finding out could lead to a better understanding of the cancer, and better treatment for all, Carson said.

"In my mind, there are two main factors that might explain why overweight and obese patients have improved survival: differences in disease biology, or differences in patient responses to chemotherapy."

It's possible that bigger patients are able to tolerate more intense chemotherapy before having severe side effects. But, Carson's team added, other research suggests that obese chemotherapy patients may tend to get lower doses relative to their body size.

Fathers and grandfathers may have longer living children

New research from Northwestern University has found that the longer fathers and grandfathers waited to have children, the more likely it was for their offspring to live longer and healthier lives.  
The study, published in the Proceedings of the National Academy of Science, seemingly stands in contrast to previous research that maintains having children younger is better for the health of the child.  Known as the paternal age effect, numerous studies have suggested that the older a man is when he reproduces, the increased likelihood that his children will develop birth defects or health-related disorders.

But according to Dan Eisenberg, a doctoral candidate in anthropology at Northwestern as well as the study’s lead author, the findings of their research don’t necessarily stand at odds with this previous research.

“I don’t think this contradicts those other findings, and we don’t recommend people have kids at a later age,” Eisenberg told FoxNews.com.  “But one major point is that what seems to be occurring is kind of interrelated with why children of older men have these mutations.”

The answer lies in a person’s telomeres – DNA found at the end of chromosomes, offering protection as cells continuously divide throughout a person’s life.  Each time a cell divides, telomeres grow shorter and shorter.  Because of their slow decay, longer telomeres are often associated with slower aging while shorter telomeres usually are behind ill health that comes with growing older.

After conducting a longitudinal study of over 1,700 young adults in the Philippines over a 30 year period, Eisenberg and his team found that children of older fathers inherit longer telomeres and even more interestingly enough – this inheritance held true across multiple generations.
Eisenberg said that the explanation could lie in every day sperm production.

“Men produce about 100 million sperm per day, while women produce all their eggs in utero and then no more are produced in their lifetime,” Eisenberg said.  “The way telomeres work is that they get a little shorter as the cell has to divide.  But in actuality if we look at sperm in older men, the sperm have longer telomeres.  But in the blood of older men, the cells have short telomeres.”

“We are not certain why telomeres are longer in sperm of older men,” Eisenberg continued, “but the most prominent explanation is that an enzyme called telomerase – which helps to extend the length of telomeres – is active at high levels in the testis. This telomerase activity could progressively extend telomere length as men age. An alternative explanation is that the sperm progenitor (stem cells) which have shorter telomere lengths tend to die out as a man ages.”

According to Eisenberg, the more replications of sperm cells that occur as a man ages, the greater the tendency for mutations to occur – which could lead to the adverse health effects that previous research has found.  So in a sense, Eisenberg’s research compliments past studies on the paternal age effect.

Where the research differs, however, is that Eisenberg’s team didn’t exactly examine fathers who reproduced at significantly older ages.  Instead they mostly compared fathers who differed from each other by a few years.

“In my reading of the literature showing these negative effects is that those tend to examine later ages,” Eisenberg said.  “Those studies tend to report that if you’re over 45 versus 65, there may be bigger effects.  With this telomere story, it’s not just about being an old versus a young father, but with every year, the telomeres get a bit longer.  So if we looked at a 20-year-old father versus a 25-year-old father, the telomere length difference would be the same between a 50 year old father and 55 year old father.”

In order to better understand their findings, the researchers hope to expand beyond just a few generations to see if this effect goes even further back in ancestry.  They also hope to understand what role this inheritance plays in the evolutionary process.

“Is this some sort of adaptive signaling – helping the father to adjust the biology of his child so it’s better to meet demands of the environment?” Eisenberg asked. “That’s our hypothesis, so we might be looking at what are other things aside from age that occur over a father’s lifespan that he gives to his children.”

Bald men and Prostate Cancer Association

If you don't have hair, you might have a higher risk of prostate cancer, a preliminary study suggests.
Researchers are reporting that bald men who underwent biopsies of the prostate were more likely to have cancer than were those with more hair on their heads.

"Bald men should be aware that they may benefit from being screened earlier and perhaps, if necessary, from being biopsied sooner," said study author Dr. Neil Fleshner, a professor of surgical urology at the University of Toronto. "In the study, the more bald people were, the more likely they were to have prostate cancer. We're 95 percent sure this is real."

However, not all doctors are ready to embrace the study's conclusions.

The possible association between male pattern baldness and prostate cancer has been considered in previous studies.

Although the precise mechanism isn't understood, researchers think male hormones known as androgens may play a role in both baldness and prostate cancer. Androgens, which include testosterone, can inhibit hair growth and trigger the development of prostate cells.

It's thought that the androgen dihydrotestosterone (DHT) increases in bald men, causing the hair follicles to shrink gradually. As the follicles get smaller, the hair weakens and eventually stops growing. DHT also has been implicated in the development of prostate cancer.

Fathers with young families are packing on the pounds

New moms fret about gaining "baby weight" but dads are the ones piling on the pounds to a dangerous level, an Australian study has found.

Time-poor, exhausted and much fatter than they realize, fathers with young families are a ticking health time bomb, research by health business Bupa shows.

Dads with kids at home are the most at risk. Three-quarters are overweight or obese, while a third believe they are slimmer than they are.

"Women are much more realistic in terms of their weight," Bupa chief medical officer Dr. Paul Bates said.

"The data showed seven in 10 men were actually overweight of those surveyed, but only three in 10 rate themselves as being overweight. With women, six in 10 were overweight but five in 10 rated themselves as being overweight."

The study found 72 percent of fathers under 40 with young families are overweight or obese while 79 percent of dads aged over 40 living with kids also tip the scales to an overweight rating.
Bates said it was clear dads were not making the link between weight and health.

"From a family point of view, it you are overweight, your kids' chance of being overweight is much also greater," he said.

"Parents need to set a good example by exercising and eating well. Being overweight gives you a much greater risk of developing diabetes, high blood pressure and arthritis."

Bates said the alarming difference between the men's perception of how fat they are and reality might be a result of society getting heavier.

"Australia is unfortunately one of the more overweight countries in the world," he said. "We measure by an absolute standard, the BMI [body mass index], but the way you judge yourself is how heavy you are compared to the people around you."

Fragile X: Chromosomal disorder affecting mainly men

Fragile X is the most common known inherited cause of developmental disabilities. The name comes from the way the X chromosome looks under a microscope; the tip shows an abnormal gap that appears broken, called a ‘fragile site’.




 The discovery of Fragile X
Fragile X was discovered in the late 1970s. In 1980 it was identified that people presenting with a group of mental and physical characteristics had a chromosomal abnormality. The gene responsible was identified by scientists in 1991.

The incidence of Fragile X
Studies estimate that around one in 2000 males are affected and roughly one in 4000 females of all races and ethnic groups. Studies indicate one in 259 women of all races carry Fragile X and one in 800 men. It is believed that this common genetic has yet to be diagnosed in 80 to 90 per cent of people with the syndrome.

Common symptoms of Fragile X
A person with full mutation Fragile X can exhibit a few or a lot of symptoms associated with this syndrome. They include:

Intellectual impairment ranging from no abnormality to mild learning difficulties, to severe learning disabilities (also known as severe mental retardation, severe mental handicap

Attention problems such as problems concentrating on a task.

Hyperactivity (overactive behavior).

Autistic like experiences and behaviors, social anxiety, hand flapping, biting, gaze aversion.

Anxiety, inability in coping with change of routine, problems relating to others, apparent over stimulation to external stimuli (e.g. traffic noise)

Unstable moods. Aggression and depression - particularly in adolescence.

Problems with hand/eye coordination

Difficulty with speech and language; echolalia (repeating words and phrases), jocular speech and up and down swings of pitch (litanic speech), palilalia (repeating the end of phrases they themselves have spoken over and over again).

Classic physical characteristics of Fragile X
These physical characteristics of Fragile X are noticable after the onset of puberity include:
Long face with a prominent jaw, prominent ears, large testicles, mostly after puberty.
People with Fragile X also are more prone to certain diseases. These include connective tissue problems, e.g. flat feet, loose joints, congenital hip dislocation, scoliosis (curvature of the spine), mitral valve prolapsed (heart valve), eye problems such as strabismus and squints.

Duchenne Muscular Dystrophy: A male inherited disease

First identified and described by the French neurologist, Guillaume Duchenne in the 1860s, Duchenne muscular dystrophy is the most common and most severe form of muscular dystrophy. It affects 1 in 3000 males and is caused by an X linked recessive gene carried by females and inherited almost exclusively by males.
Sings symptoms Duchenne Muscular Dystrophy
First signs of the disease become apparent between the age of two and five years. Toddlers are often late in learning to walk. Muscular weakness leads to frequent falls, a clumsy walk and poor running ability. The child has a waddling unsteady gait.
The disease gradually weakens skeletal and voluntary muscles in the arms, legs and trunk. The child with Duchenne muscular dystrophy (DMD) usually loses the ability to walk between the ages of seven and twelve. As muscle tissue wastes away it is not replaced. By the teens respiratory and heart muscles are often involved.
There is a higher frequency of intellectual impairment in people with DMD than in the general population. Intellectual impairment, unlike muscular weakness, is not a progressive condition.
Diagnosis muscular dystrophy
Diagnosis is made by history and observation of the physical symptoms. Muscle biopsy and a blood test to test for high levels of creatine kinase (CK) will confirm diagnosis of DMD.
Treatments for Duchenne Muscular Dystrophy

At the present time there is no cure for this disease.

Exercise and muscle stretching can help slow and relieve contracture. Surgery can also help correct contractures.

Scoliosis, or curvature of the spine, can be very severe. Major surgery can also help by inserting a metal rod to straighten and hold the spine in place. Duchenne muscular dystrophy is usually fatal by the age of 25 years.
Genetic Testing Duchenne muscular dystrophy
A genetic test can be offered to family members to detect the presence of the genetic defect. This will allow females to find out if they are carriers of the disease.

Lorenzo's Oil Adrenoleukodystrophy: Male Genetic Disorder

Before the release of the film Lorenzo's oil, few people will have heard of the rare genetic disease Adrenoleukodystrophy (ALD). The movie helped to raise awareness of the condition by following the struggle of one family to find a cure for this debilitating neurological disease. After two years of careful research and pushing the specialists in the field to reveal information, the family of young Lorenzo Odone finally invented an oil that, when taken, had an effect on the fatty acids that are the cause of the problem. The oil, extracted from a combination of rapeseed and olive oil has had its therapeutic effects verified by a 10 year study.
Adrenoleukodystrophy affects only males.
Research & Adrenoleukodystrophy
Research on Lorenzo's oil was conducted over a 10-year trial on 104 boys with the ALD gene. All the boys were under the age of six and symptom free on commencement of the trial. Dr Hans Moser, the lead researcher, found that the boys who were not given Lorenzo's oil scrupulously were nearly three times as likely to develop symptoms as those who were given it as prescribed. However, one possible problem is that the study is a small and ran with no placebo group. It is still possible therefore that the boys could develop ALD symptoms in the adult form of the disorder.
What is Adrenoleukodystrophy?
Adrenoleukodystrophy is transmitted as an X-linked trait. Its incidence is estimated at 1 out of 20,000 to 1 in 50,000 and affects all races. ALD is a metabolic defect in the accumulation of long chain fatty acids in the nervous system, adrenal gland, and testes, where the accumulated material disrupts normal activity. What results is impairment and eventual loss of neural impulses throughout the body. Bodily functions deteriorate and eventually brain damage occurs. Without treatment many boys are bedridden and they die before reaching their teens. The adult form of the disease becomes evident in late teens and early 20s, it progresses more slowly.
Treatment for Adrenoleukodystrophy
The main treatment remains bone marrow transplantation and this is still seen as the best hope of survival. Lorenzo's oil can be said at present to delay symptoms and further trials are required . Dr Moser is now recommending that all presymptomatic boys with Adrenoleukodystrophy be given Lorenzo's oil.
Lorenzo Odone was 28 years old on May 29, 2006 and severely disabled. Sadly the discovery his parents made was too late to prevent severe and progressive damage but his father believes Lorenzo's oil has prolonged his life.

Bladder Tumors: More Common in Men

Basic facts about bladder tumors
A bladder tumor is an excessive reproduction of cells that line the bladder. Most tumors are noncancerous called papillomas, a wart like growth. Cancerous bladder tumors can spread through the bladder wall and into other organs via the blood stream.

Bladder tumors are three times more common in men than in women.

Bladder tumors are most common in white men aged over 50 years.

Less than 1 percent of cases of bladder cancer occur in people under 40 years old

Bladder tumors are the second most common tumor that can occur in the reproductive and urinary tract. (The most common is a prostate tumor).

Tumors of the lining of the bladder cause about 4% of all cancers diagnosed in the United States.

Bladder tumors can be cancerous or noncancerous (benign).

Causes of bladder tumors
Causes of bladder tumors include;
Exposure to carcinogenic chemicals, that is, chemicals that are known to cause cancer. These include chemicals used in the rubber and dye industries.
Smoking tobacco.
Chronic urinary tract infections.
Schistosomiasis, a parasitic infection common in the tropics.
Signs and symptoms of bladder tumors
The signs and symptoms of bladder tumors can include the following;
Blood in the urine. This symptom is very common in bladder cancer.
A feeling that you urgently need to pass urine.
You may need to pass urine more frequently. You often pass smaller amounts of urine.
Back or abdominal pain.
Most bladder tumors are painless.
Appetite loss.
Weight loss.

Signs and symptoms can and do vary depending on the type of bladder tumor, size and spread of the disease.

Do I Have Prostate Disease?

Every man should be familiar with the symptoms of the three main types of prostate disorders, because early detection is the best defense against advancing and worsening disease. These three conditions - benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer -  all have similar symptoms, as well as a few different ones, which is one reason why it is important to get routine prostate examinations.

Another reason to get a routine prostate examination is that in the early stages of prostate cancer, the disease typically does not give men any hint that cancer is in the offing. Only a trained medical professional can help you determine whether you have prostate cancer or another prostate condition.
That said, the symptoms that are similar among the three prostate conditions include the following:

• Having to wait for the urinary stream to begin
• Urinary flow that starts and stops
• Weak urinary stream
• Dribbling urine
• Frequent need to urinate
• Incomplete urination (inability to completely empty the bladder)
• Frequent nighttime urination (nocturia)
• Urgent need to urinate
• Urinary tract infections
• Urinary incontinence (leakage)
• Inability to urinate (this is an emergency situation)

Men who have prostatitis may experience pain when ejaculating and/or pain in the genital or pelvic area. In cases when prostate cancer is advanced and has spread (metastasized) beyond the prostate, it can cause other symptoms, depending on where it is. Cancer that has metastasized to the bones, for example, can cause aching bone and fractures, while involvement of the lymph nodes in the pelvis can cause swelling in the legs. Other symptoms associated with more advanced prostate cancer include:

• Unexpected weight loss
• Anemia
• Bloody semen or urine
• Lower back or abdominal pain
• Fatigue

The severity of symptoms of BPH and Prostatitis may initially be determined by the results of the International Prostate Symptoms Test as well as other tests to detect and diagnose both BPH and prostatitis. The nature and extent of the symptoms and severity of the diagnosis will determine the appropriate treatment option(s). With prostate cancer, the Prostate Symptoms Test may be used as part of the screening process in conjunction initially with a DRE (Digital Rectal Exam) and PSA blood test. Protect your prostate health. If you are experiencing any of the symptoms mentioned here, see your healthcare provider as soon as possible for an examination. If any prostate condition is brewing, you want to catch it before it has a chance to move forward.

Guide To Osteoporosis In Men- Issue No.3

How Is Osteoporosis Diagnosed In Men?

Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. A medical work-up to diagnose osteoporosis will include:

• a complete medical history
• x-rays
• urine and blood tests

The doctor may also order a BMD test or bone mass measurement. A special type of x-ray, the BMD test requires trace amounts of radiation. It is safe, accurate, quick, painless, and noninvasive and can be used to detect low bone density, predict risk for future fractures, diagnose osteoporosis and monitor the effectiveness of treatments.
It is increasingly common for women to be diagnosed with osteoporosis or low bone mass using a BMD test, often at mid-life when doctors begin to watch for signs of bone loss. In men, however, the diagnosis is often not made until the patient sees his doctor complaining of back pain or until a fracture occurs. This makes it especially important for men to inform their doctor about:

• risk factors for developing osteoporosis
• loss of height
• change in posture
• a fracture
• sudden back pain

Some doctors may be unsure how to interpret the results of a BMD test in male patients. For example, it is not known whether the guidelines used to diagnose osteoporosis or low bone mass in women (developed by the World Health Organization) are also appropriate for men. Until that question is answered--and until separate criteria are established for men, if necessary--most experts suggest using the WHO criteria for men.

What Treatments Are Available?

Once a man has been diagnosed with osteoporosis, his doctor may prescribe one of the medications approved by the Food and Drug Administration (FDA) for this disease.

Fosamax (Alendronate) has been approved for the treatment of the disease in men and postmenopausal women.

Actonel (Risedronate) and Fosamax (Alendronate) are approved for the treatment of glucocorticoid-induced osteoporosis in both men and women.

Forteo (Teriparatide) is approved for the treatment of osteoporosis in men and women who are at increased risk of fracture. The treatment plan will also likely include other nutrition, exercise, and lifestyle guidelines for preventing bone loss.
If bone loss is due to glucocorticoid use, the doctor may prescribe a bisphosphonate, monitor bone density and testosterone levels and may suggest using the minimal effective dose of glucocorticoid, discontinuing the drug when practical, and/or topical (skin) administration.
Other possible prevention or treatment approaches include:

calcium and/or vitamin D supplementation

testosterone replacement

osteoporosis treatment medications such as bisphosphonates

If osteoporosis is the result of another condition (such as testosterone deficiency) or exposure to certain medications, the doctor may design a treatment plan to address the underlying cause.

Recommendations for Calcium and Vitamin D Intake in Men

Age 19-30: 1,000mg for calcium and (no recommendation) for Vitamin D

Age 31-50: 1,000mg for calcium and 200IU for Vitamin D

Age 51-70: 1,200mg for calcium and 400IU for Vitamin D

Age 70+: 1,200mg for calcium and 600IU for Vitamin D

Upper limit: 2,500mg for calcium and 2000IU for Vitamin D

How Can Osteoporosis Be Prevented in Men?

There have been fewer research studies on osteoporosis in men than in women. However, experts agree that all people should take the following steps to preserve their bone health.

• Avoid smoking.
• Reduce alcohol intake.
• Increase levels of physical activity.
• Ensure a daily calcium intake that is adequate for your age.
• Discuss with the doctor the use of medications, such as corticosteroids, that are known to cause bone loss.
• Recognize and treat any underlying medical conditions that affect bone health.
• Ensure an adequate vitamin D intake. (Normally, the body makes enough vitamin D from exposure to as little as 10 minutes of sunlight a day. If exposure to sunlight is inadequate, dietary vitamin D intake should be at least 400 IU but not more than 800 IU/day; 400 IU is the amount found in one quart of fortified milk and most multivitamins.)
• Engage in a regular regimen of weight-bearing exercises where bones and muscles work against gravity.
Weight-bearing exercise includes:

• walking
• jogging
• racquet sports
• stair climbing
• team sports
• lifting weights
• using resistance machines

A doctor should evaluate the exercise program of anyone already diagnosed with osteoporosis or arthritis to determine if twisting motions and impact activities, such as those used in golf, tennis, or basketball, need to be curtailed.

Guide To Osteoporosis In Men- Issue No.2

Primary and Secondary Osteoporosis in Men

There are two main types of osteoporosis: primary and secondary.
In cases of primary osteoporosis, the condition is either caused by age-related bone loss (sometimes called senile osteoporosis) or the cause is unknown (idiopathic osteoporosis). The term idiopathic osteoporosis is used only for men less than 70 years old; in older men, age-related bone loss is assumed to be the cause.

At least half of men with osteoporosis have at least one (sometimes more than one) secondary cause.
In cases of secondary osteoporosis, the loss of bone mass is caused by certain lifestyle behaviors, diseases or medications.

Causes of Secondary Osteoporosis in Men

Glucocorticoid excess

Other immunosuppressive drugs

Anticonvulsant drugs

Hypogonadism

Alcohol excess

Smoking

COPD

Asthma

Cystic fibrosis

Gastrointestinal disease

Hypercalciuria (a disorder that causes too much calcium to be lost in the urine)

Hyperthyroidism

Hyperparathyroidism

Immobilization

Osteogenesis imperfecta

Homocystinuria

Neoplastic disease

Ankylosing spondylitis

Rheumatoid arthritis

Systemic mastocytosis

Glucocorticoid excess

Bone loss is a very common side effect of these drugs. In fact, exposure to glucocorticoids accounts for 16-18% of osteoporosis in men.
The damage these drugs cause may be due to their direct effect on bone, muscle weakness or immobility, reduced intestinal absorption of calcium, a decrease in testosterone levels or, most likely, a combination of these factors.
Bone mass often decreases quickly and continuously with ongoing use of glucocorticoids, with most of the bone loss in the ribs and vertebrae. About one-third of patients have evidence of vertebral fractures after 5 to 10 years of treatment with glucocorticoids. The risk of hip fracture is increased nearly three-fold. Therefore, patients taking these medications should talk to their doctor about having a bone mineral density (BMD) test; men should also be tested to monitor testosterone levels, as glucocorticoids often reduce testosterone in the blood.
A treatment plan to minimize damage to bone during long-term glucocorticoid therapy may include:

using the minimal effective dose

discontinuation of the drug when practical

topical (skin) administration if possible

Adequate calcium and vitamin D nutrition is important, as these nutrients help reduce the impact of glucocorticoids on bone. Other possible treatments include testosterone replacement and medication. Alendronate and risedronate are two bisphosphonate drugs approved by the FDA for use by men and women with glucocorticoid-induced osteoporosis.

Hypogonadism

Hypogonadism refers to abnormally low levels of sex hormones. It is well known that loss of estrogen causes osteoporosis in women. In men, reduced levels of the sex hormones may also cause osteoporosis. In fact, it is estimated that up to 30% of men with osteoporotic vertebral fractures have low testosterone levels. While it is natural for testosterone levels to decrease with age, there should not be a sudden drop in this hormone comparable to the drop in estrogen experienced by women at menopause. However, medications like steroids, cancer treatments (especially for prostate cancer), and many other factors can affect testosterone levels.
Testosterone replacement therapy may be helpful in preventing or slowing bone loss. Its success depends on factors such as age and how long testosterone levels have been reduced. Also, it is not yet clear how long any beneficial effect of testosterone replacement will last; therefore, doctors will usually treat the osteoporosis directly, using medications approved for this purpose.
Recent research suggests that estrogen deficiency may be a cause of osteoporosis in men. For example, estrogen levels are low in men with hypogonadism and may play a part in bone loss. Osteoporosis has been found in some men who have rare disorders of estrogen action. Therefore, the role of estrogen in men is under active investigation.

Alcohol abuse

There is a wealth of evidence that alcohol abuse may decrease bone density and lead to an increase in fractures. Low bone mass is found in 25 to 50% of men who seek medical help for alcohol abuse. One early study found the bone mass of young alcoholic males to be comparable to that of elderly females.
In cases where bone loss is linked to alcohol abuse, the first goal of treatment is, of course, to help the patient stop--or at least reduce--his consumption of alcohol.

Smoking

Bone loss is more rapid, and rates of hip and vertebral fracture are higher, among men who smoke, although more research is needed to determine exactly how smoking damages bone. Tobacco, nicotine and other chemicals found in cigarettes may be directly toxic to bone or they may inhibit absorption of calcium and other nutrients needed for bone health. Quitting is the ideal approach, of course, as smoking is harmful in so many ways.

Gastrointestinal disorders

Several nutrients, including amino acids, calcium, magnesium, phosphorous and vitamins D and K are important for bone health. Diseases of the stomach and intestines can lead to bone disease when they impair absorption of these nutrients. Treatment for bone loss in this case may include supplementation of the poorly absorbed nutrient(s).

Guide To Osteoporosis In Men Issue No. 1

Osteoporosis, a disease that causes the skeleton to weaken and bones to break, is a significant threat to more than two million men in the U.S. today.

Experts estimate that:

one-fifth to one-third of all hip fractures occur in men.

symptomatic vertebral (spine) fractures occur about half as often in men as in women.

after age 50, six percent of all men will suffer a hip fracture as a result of osteoporosis.

in 1994, osteoporotic fractures in men accounted for annual costs of $2.7 billion, or one-fifth of the total cost of osteoporotic fractures in the U.S.

Despite these compelling figures, a majority of American men view osteoporosis solely as a "woman's disease," according to a 1996 Gallup Poll. Moreover, among men whose lifestyle habits put them at increased risk, few recognize the disease as a significant threat to their mobility and independence.

Osteoporosis develops less often in men than in women because men have larger skeletons, bone loss starts later and progresses more slowly, and there is no period of rapid hormonal change and accompanying rapid bone loss. However, in the last few years the problem of osteoporosis in men has been recognized as an important public health issue, particularly in light of estimates that the number of men above the age of 70 will double between 1993 and 2050.

Clearly, more information is needed about the causes and treatment of osteoporosis in men, and researchers are beginning to turn their attention to this long-neglected group. For example, in 1999, the NIH launched a major research effort that will attempt to answer some of the many questions that remain. The seven-year, multi-site study will follow more than 5,000 men ages 65 and older to determine how much the risk of fracture in men is related to:

• bone mass and structure
• biochemistry
• lifestyle
• tendency to fall
• other factors

The results of such studies will help physicians better understand how to prevent, manage and treat osteoporosis in men. But much is already known.

What Causes Osteoporosis In Men?

Bone is constantly changing - that is, old bone is removed and replaced by new bone. During childhood, more bone is produced than removed, so the skeleton grows in both size and strength. The amount of tissue or bone mass in the skeleton reaches its maximum amount by the late twenties. By this age, men typically have accumulated more bone mass than women. After this point, the amount of bone in the skeleton typically begins to decline slowly as removal of old bone exceeds formation of new bone.
In their fifties, men do not experience the rapid loss of bone mass that women have in the years following menopause. By age 65 or 70, however, men and women lose bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes.
Once bone is lost, it cannot be replaced. Excessive bone loss causes bone to become fragile and more likely to fracture. This condition, known as osteoporosis, is called a "silent disease" because it progresses without symptoms until a fracture occurs.

Fractures resulting from osteoporosis can be permanently disabling and most commonly occur in the:

• hips
• spine
• wrists

Hip fractures are especially likely to be disabling. Perhaps because such fractures tend to occur at older ages in men than in women, men who sustain hip fractures are more likely to die from complications than are women. More than half of all men who suffer a hip fracture are discharged to a nursing home, and 79% of those who survive for one year after a hip fracture still live in nursing homes or intermediate care facilities.

What Are The Risk Factors For Men?

Several risk factors have been linked to osteoporosis in men:

Chronic diseases that affect the kidneys, lungs, stomach, and intestines or alter hormone levels.

Undiagnosed low levels of the sex hormone testosterone.

Unhealthy lifestyle habits (e.g., smoking, excessive alcohol use, low calcium intake, inadequate physical exercise).

Age: The older you are, the greater your risk.

Heredity: A son is almost four times as likely to have low bone mineral density (BMD) if his father has low BMD, and nearly 8 times as likely if both parents have low BMD.

Race: Caucasian men appear to be at particularly high risk, but all men can develop this disease.

Fibromyalgia in Men

Fibromyalgia is often thought of as a "women's condition," but men can have it as well.
Men with fibromyalgia are definitely outnumbered -– with women making up about 90% of cases –- but that doesn't mean the diagnosis shouldn't be considered in men. After all, according to National Fibromyalgia Association estimates, that 10% could mean one million men are living with illness.
Because of the gender disparity, however, we know a lot more about how fibromyalgia affects women. Many studies are done with exclusively female participants, and most doctors have a lot more practical experience with female fibromyalgia patients.
A lot of people and even some doctors erroneously think that men don't get fibromyalgia. This can cause special problems for men who are living with it, both in getting a diagnosis and in finding support. Societal expectations and stereotypes of men pose their own problems as well.

Hormonal Differences

The most obvious difference between fibromyalgia in men versus women is hormonal. In women, flares are often tied to the menstrual cycle, and hormonal events such as menopause or hysterectomy may trigger symptoms.
Certainly, men don't have such obvious hormonal events to focus on. So far, studies examining male hormonal fluctuations or abnormalities in fibromyalgia simply haven't been done, so we don't know what role, if any, these hormones play. Generally speaking, though, we do have evidence that male hormones impact pain in certain ways.
Testosterone, the primary male hormone, is thought to play a beneficial role when it comes to pain in general. Research suggests that it may help prevent muscle fatigue and, in combination with a certain protein, may help repair muscles after exercise. Male hormones may also modulate other biological processes related to fatigue and pain.
We also know of gender-based differences in the stress hormone cortisol, which research suggests is low in fibromyalgia. One study published in Health Psychology in 2008 showed that cortisol levels were different in happily married women than in their unhappily married counterparts, while men didn't exhibit any differences based on marital happiness. Researchers speculated that this could explain why conditions involving low cortisol are more likely in women.

Brain Chemistry

The brains of men and women are not identical. One difference that may influence what fibromyalgia is like for each gender is the neurotransmitter (chemical messenger) serotonin.
Serotonin is believed to play a key role in fibromyalgia. Its areas of influence include pain, sleep, anxiety and depression. Some research suggests that the serotonin system works differently in men than in women.
A 2008 study published in Neuroimage showed that men have fewer serotonin receptors (brain cells that respond to it) than women. However, the process of reuptake –- which is essentially "recycling" so the neurotransmitter can be used again -– may be more efficient in men.
Drugs that slow reuptake are commonly prescribed for fibromyalgia. They're called SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin norepinephrine reuptake inhibitors. Two of the three drugs approved for this condition are SNRIs: Cymbalta (duloxetine) and Savella (milnacipran).
Because of the gender differences in the serotonin system, some doctors have suggested that these drugs be tested on men and women separately. This hasn't happened yet, but we do have anecdotal evidence that men and women respond differently to these drugs.
A separate study published in Biological Psychiatry in 2007 showed that lowering the body's serotonin levels doesn't affect men and women in the same way. In women, it caused worsening mood and increased cautious behavior. Men didn't have mood changes at all but became more impulsive, the researchers say.
These kinds of differences, which we don't fully understand, could make fibromyalgia harder to spot for doctors accustomed to seeing mood problems in their female patients.

Is Sleep More Important in Men?
A study published in 2012 in Psicothema looked at gender differences in the major fibromyalgia symptoms, including pain, sleep, fatigue, psychological disorders, emotional distress, and function.

Researchers found that sleep quality was the best predictor of pain in men but not in women.
Fibromyalgia is known to involve sleep abnormalities and often overlaps with one or more sleep disorders. This research suggests that identifying and treating sleep problems may be more important for men.

Psychological & Social Impact
Our society has certain expectations of men and specific ideas about what it is to be masculine. Even in a two-income household, the man is often thought of as the primary breadwinner. Men are supposed to be hard-working, tough, and oblivious to pain.
Everyone with fibromyalgia faces the misconception that we're crazy, lazy or both. When a man has a debilitating pain condition, people may also view him as weak and think especially badly of him if he doesn't have a job. He may view himself this way as well.
Men with fibromyalgia report feeling like they've failed as a husband, father, and provider. It's a huge blow to the ego to be knocked down with what's sometimes considered a "women's condition."
It's important to remember that illness is not weakness. Instead, the ability to keep functioning at any level when you're sick shows tremendous strength.
Also remember that it's not weakness to need mental-health counseling to deal with these issues. It may help you overcome mental and emotional barriers to getting better.

Getting a Diagnosis

If you suspect you have fibromyalgia, bring it up to your doctor, as he or she may not consider it because they're so accustomed to seeing it in women.
If your doctor dismisses the idea based on your gender, you may need to be persistent about it or see another doctor.

Number of Drinks and Blood Alcohol Content (BAC): Information For Men

Here is a general guide to estimating your Blood Alcohol Concentration (BAC), based on your body weight and speed of drinking:

One Drink

One American standard drink will, on average, produce a Blood Alcohol Concentration of about 0.02, and most light and moderate drinkers will feel some subtle effects at this level.
After a man has one standard drink…

• If he weighs 100 pounds, he will have a Blood Alcohol Concentration of 0.04. If he drinks it over one hour, he will have a Blood Alcohol Concentration of 0.02, and if he drinks it over two hours, he will have a Blood Alcohol Concentration of 0.01. Only after three hours will he have a Blood Alcohol Concentration of 0.00.
• If he weighs 150 pounds, he will have a Blood Alcohol Concentration of 0.03. If he drinks it over one hour, he will have a Blood Alcohol Concentration of 0.01, and after two hours, he will have a Blood Alcohol Concentration of 0.00.
• If he weighs 200 pounds, he will have a Blood Alcohol Concentration of 0.02. If he drinks it over one hour, he will have a Blood Alcohol Concentration of 0.003, and after two hours, he will have a Blood Alcohol Concentration of 0.00.

So after just one drink, even larger men take around two hours for their Blood Alcohol Concentration to return to zero.

Two Drinks

Two American standard drinks will, on average, produce a Blood Alcohol Concentration of about 0.04, and most light and moderate drinkers will feel relaxed at this level. Reaction times will be slowed, and fine motor skills will be affected to the extent that driving will be impaired.
After a man has two standard drinks…

• If he weighs 100 pounds, he will have a Blood Alcohol Concentration of 0.08. If he drinks them over one hour, he will have a Blood Alcohol Concentration of 0.06, and if he drinks them over two hours, he will have a Blood Alcohol Concentration of 0.04. After three hours, his Blood Alcohol Concentration will be down to 0.03, after four hours, it will be down to 0.01, and only after five hours will he have a Blood Alcohol Concentration of 0.00.
• If he weighs 150 pounds, he will have a Blood Alcohol Concentration of 0.05. If he drinks them over one hour, he will have a Blood Alcohol Concentration of 0.04, and after two hours, he will have a Blood Alcohol Concentration of 0.02. After three hours, his Blood Alcohol Concentration will be down to 0.003, and after four hours, it will be down to 0.00.
• If he weighs 200 pounds, he will have a Blood Alcohol Concentration of 0.04. If he drinks them over one hour, he will have a Blood Alcohol Concentration of 0.004, and after two hours, he will have a Blood Alcohol Concentration of 0.00.

So after two drinks, it takes four to six hours for your Blood Alcohol Concentration to return to zero.

Three Drinks

Three American standard drinks will produce, on average, a Blood Alcohol Concentration of about 0.06, at which point the negative effects of alcohol become apparent. At this level, judgment will be impaired, often affecting people’s ability to make rational decisions, particularly around risk taking activities such as driving and continuing to drink. Perception, learning, memory, coordination, sexual arousal, alertness and self-control will also be impaired.
After a man has three standard drinks…

• If he weighs 100 pounds, he will have a Blood Alcohol Concentration of 0.11. If he drinks them over one hour, he will have a Blood Alcohol Concentration of 0.10, and if he drinks them over two hours, he will have a Blood Alcohol Concentration of 0.08. After three hours, his BAC will still be at 0.07, and after four hours, it will be at 0.05. After five hours, it will be down to 0.03, after six hours, it will be at 0.02, and after six hours, it will be at 0.001. Only after a whopping seven hours will he have a Blood Alcohol Concentration of 0.00.
• If he weighs 150 pounds, he will have a Blood Alcohol Concentration of 0.08. If he drinks them over one hour, he will have a Blood Alcohol Concentration of 0.06, and after two hours, he will have a Blood Alcohol Concentration of 0.04. After three hours, his Blood Alcohol Concentration will be down to 0.03, and after four hours, it will be down to 0.01. By five hours, it will be down to 0.00.
• If he weighs 200 pounds, he will have a Blood Alcohol Concentration of 0.06. If he drinks them over one hour, he will have a Blood Alcohol Concentration of 0.004, and after two hours, he will have a Blood Alcohol Concentration of 0.02. After three hours, his Blood Alcohol Concentration will be down to 0.01, and after four hours, it will be down to 0.00.

Six Drinks

The effects noted at the three drink level (or a Blood Alcohol Concentration of 0.06) will become more pronounced with each additional drink. By the time you reach six American standard drinks, which will produce, on average, a Blood Alcohol Concentration of about 0.12, vomiting usually occurs, unless this level is reached slowly, or you already have tolerance to alcohol. Vomiting is the body’s first line of defense against overdose.

• This Blood Alcohol Concentration level would be reached by a 100-pound man quickly, by drinking three drinks in less than one hour, or four drinks over two hours.
• A 150-pound man would reach this level consuming six drinks over two to three hours.
• A 200-pound man would reach this level if he drank six drinks in less than one hour. If these people drank more slowly, it might take eight or nine drinks to reach this level over two or three hours.

Seven to Eight Drinks

At the point where your Blood Alcohol Concentration reaches 0.15, you have the equivalent of half a pint of whisky circulating in your bloodstream. Most people have difficulty walking in a straight line at this point.

Ten Drinks

With a Blood Alcohol Concentration of 0.2, most people experience a “blackout,” having no memory of all or part of what happened during the period their Blood Alcohol Concentration was at this level. In younger people, this level can be fatal.

Fifteen Drinks

At the Blood Alcohol Concentration level of 0.3, most people lose consciousness.

Twenty Plus Drinks

The Blood Alcohol Concentration level of 0.45 is the average fatal dose for adults, at which point breathing and heartbeat stop.

So, How Much To Drink?

In general, three drinks or more will produce negative effects. These negative effects will increase the more you drink, and the more quickly you drink. However, because your perception, impulsiveness and self-control are inhibited, you may not be aware of how badly you are impaired. These effects are particularly pronounced in smaller, lighter men.
If sticking to two drinks doesn’t seem worth it, or if you don’t think you can stick to just two drinks, then you might be better off if you didn’t even bother drinking. That way, you would not have to worry about driving home, or about problems caused by intoxication. It is also worth knowing that the majority of sexual assaults occur when one or both people have been drinking. So having more than three drinks at a bar, club or party may leave you particularly vulnerable to this.

Angry, Low Control Men Should Not Drink

Despite its powerful pharmacological effects on the central nervous system, alcohol does not facilitate aggression in all persons or in all situations. Trait anger – a tendency to experience frequent and intense episodes of anger – has already been identified as a risk factor for alcohol-related aggression. Yet possessing high levels of trait anger does not necessarily guarantee that an intoxicated individual will become aggressive when provoked.

A study in the issue of Alcoholism: Clinical and Experimental Research finds that a person's inability to control the outward expression of their anger plays a key role in alcohol-related aggression.

"Our previous research showed that men with high levels of trait anger are most at risk for becoming violent when they drink," said Peter R. Giancola, associate professor of psychology, director of the University of Kentucky Alcohol Research Laboratory, and corresponding author for the study. "This study adds to that by showing that the combination of high trait anger and low anger control even further increases your risk.'" "This topic is exceedingly relevant as, generally, alcohol intoxication co-occurs with violence in approximately half of all rapes, murders and assaults, including family violence," added Robert O. Pihl, professor psychology and psychiatry at McGill University. "The significance of this correlation is typically ignored by society, possibly because the nature of the relationship remains argumentative. This study and others like it are slowly illuminating the mechanisms and vulnerabilities involved in the alcohol/aggression relationship."

Researchers examined 164 healthy male social drinkers (159 Caucasians, 5 African Americans) between the ages of 21 and 35 years who were recruited through local advertisements and paid for their participation. Trait anger and anger control were assessed with the State-Trait Anger Expression Inventory. Participants were given either an alcoholic (1g/kg alcohol) or a placebo beverage, and then participated in a laboratory aggression task.

Loss of Control is the Key

Higher levels of trait anger were associated with increased aggression, but only among men who were intoxicated and also reported low levels of anger control.

"Most if not all individuals who drink and drink heavily do so without becoming violent," said Pihl. "Thus, the phenomenon invariably involves an alcohol effect, plus a specific type of situation, and the inability to deal with that situation. The Giancola paper suggests that the inability to control anger is an important factor in the equation. For individuals who fit the characteristics described by Giancola, drinking during emotionally provocative situations de facto is a license to aggress. Just like in the case of driving, this is a time these individuals should avoid alcohol. Further, these individuals might be wise to avail themselves of numerous intervention programs specifically designed to enhance anger control."

Giancola added "research indicates that alcohol increases aggression by reducing fear, increasing arousal, and impairing cognitive functioning. However, being in this disinhibited state does not mean that one will necessarily become aggressive," he said. "They might also become more talkative, jovial, or sexual." The over-arching aim of his entire research program, said Giancola, is to determine what factors are most important in increasing one's risk for intoxicated aggression.

"Once these risk factors are identified, we will attempt to prevent them in children," he said.

The Physical Effects of Alcoholism

The statistics are not good. About 14 million people in the United States abuse alcohol or are alcoholic, that's 1 in every 13 adults according to the NIAAA. Statistics indicate that across all ages men are four times more likely than women to be heavy drinkers. Men are twice as likely to be alcohol abusing or alcohol dependant. Compulsive drinking causes major health problems. Each year more than 100,000 Americans die of alcohol-related causes.

Alcohol abuse damages the nervous system and destroys brain cells
Different parts of the brain are more sensitive to alcohol than others. Alcohol is a toxin that damages the transmission of nerve impulses in the brain and nervous system. Chronic alcohol abuse causes organic damage that manifests itself both physically, psychologically and in the behavior of people affected.
Physically it is manifested through loss of balance, impotence, numbness of the feet and hands, tremor and in blindness.

Psychologically and behaviorally by loss of intellectual abilities, impaired ability to learn and in mental confusion.

Alcohol abuse causes a condition called delirium tremens in which the person experiences mental confusion, extreme excitement, anxiety, trembling, rapid pulse and hallucinations.

Alcohol abuse causes cirrhosis of the liver
Alcoholism and alcohol abuse damages the liver. If the damage is severe it is known as cirrhosis. Cirrhosis can lead to liver failure, liver cancer and death.

Alcohol abuse causes infection and chronic inflammation
Inflammation of the stomach (gastritis) and digestive system leads to ulceration. Perforation of the stomach and intestines is life threatening. Inflammation of the digestive system means that food is not digested or absorbed properly.

Inflammation and infections are associated with poor diet, malnutrition, lifestyle changes, accidents and self neglect. Diseases include pneumonia, kidney and urinary tract infections, kidney failure and pancreatitis.

Alcohol abuse causes malnutrition
Vitamin deficiency is due to an inability to absorb or a lack of various vitamins. Wernicke's disease and Korsakoff's syndrome are characterized as a memory disorders caused by a deficiency of vitamin B1, also called thiamine.

Alcohol abuse causes Cardiovascular problems
Excessive drinking can lead to high blood pressure, it can damage your heart muscle (cardiomyopathy). Damage to the cardiovascular system can put you at increased risk of heart failure or stroke.

Alcohol abuse causes sexual problems
Erectile dysfunction is common in men with alcohol problems

Alcohol abuse can cause Cancer
Alcoholism has been linked to a higher risk of cancer of the esophagus, larynx, colon and the liver.

The Facts about Heart Attacks

A heart attack, also called coronary thrombosis or myocardial infarction, occurs when there is an obstruction to the flow of blood in one of the two branches of the coronary arteries. Any substantial disruption to the flow of oxygen and nutrients to the heart muscle interferes with heart function and can threaten the survival of heart tissue itself.
Obstruction of the coronary arteries occurs when a blood clot forms because of a build-up of fatty, roughened plaque, containing cholesterol and other material called atheroma, in the inner lining of the arteries. Narrowing and thickening of the arterial wall is called arteriosclerosis.
Each year, about 700,000 Americans die from heart attacks. Coronary heart disease is responsible for about half of all deaths in Western countries. Men are at greater risk than pre-menopausal women.

Risk Factors for Heart Attacks

There are certain conditions that can increase your chances of developing heart disease, such as obesity, smoking, diabetes, lack of exercise, high blood pressure, high blood cholesterol, stress, a family history of heart disease, age, and gender. Although we have little control over some of these conditions, our lifestyle does have a big influence. Stopping smoking, eating a balanced diet, and regularly exercising are recognized as highly effective protective mechanisms. High cholesterol, high blood pressure and smoking can double your chances of a heart attack. If you have all three risk factors, then you can be eight times more at risk than someone with none of them!

Signs and Symptoms of Heart Attacks

There is evidence that up to 20 percent of people who have heart attacks only experience mild symptoms, some symptoms, or no symptoms at all. Most people experience some or all of the following:

• Severe chest pain (angina)


• Tightness, heaviness, or pressure or a squeezing feeling in the chest. It can also be felt in the neck, down the arms (particularly the left arm), and in the shoulder.


• A faint and often irregular pulse


• Shortness of breath


• Restlessness


• Fear

Assessing Your Own Risk For Heart Disease

It is important for you to know how to assess your own risk for heart disease.

The bad news about heart disease is that it remains extremely prevalent in our society. The good news is that the factors that determine our risk of developing heart disease are, to a large extent, under our control. We ourselves have a lot to say about whether we will develop early cardiac disease.

Your doctor is supposed to assess your risk for you, and coach you on what you should be doing to reduce that risk. But, despite pleas from medical experts and professional societies to do so, many doctors are still bad at performing risk assessments, and are particularly terrible about spending the necessary time to instruct their patients on appropriate steps to reduce that risk.

(Note well: Doing a simple risk assessment is one of the most important jobs the primary care physician does. The failure to do such a risk assessment probably ought to be considered evidence that your doctor may be doing sub-standard work. Many of the things doctors need to think about are complicated - this one isn't.)

Fortunately, the tools exist today for you to accurately estimate your own risk of getting heart disease, without waiting for your doctor to initiate the action. And lots of information is available as to what to do about it if your risk is elevated.

To assess your own risk, here's what you need to know

You need to gather the following information:

• whether you smoke or not
• your total and HDL cholesterol levels
• your blood pressure
• whether you have evidence of diabetes or metabolic syndrome
• whether you are overweight for your age and height
• whether close relatives have had premature heart disease

With this information, you can place yourself into one of three categories: low, intermediate, or high.
To be in the low risk category, all of the following must be present:

• nonsmoker
• total cholesterol less than 200 mg/dL, HDL cholesterol greater than 40 mg/dL
• systolic BP less than 120, diastolic BP less than 80
• no evidence of diabetes
• not overweight
• no family history of premature cardiovascular disease

You are in the high risk category if you have any of the following:

• known coronary artery disease or other vascular disease
• type 2 diabetes
• over age 65 with multiple (more than one) risk factors

And you are in the intermediate risk group if you don't fit into either the low or high risk groups.
If you are at low risk, you do not need any special medical interventions to reduce your risk, except perhaps for routine coaching on maintaining a healthy lifestyle. About 35% of U.S. adults fall into this category.

If you are in the high risk group, your doctor should strongly consider placing you on appropriate treatments that have been proven to reduce the risk of heart attack and death, such as statin drugs, beta blockers, and/or aspirin. In addition, your doctor may want to do a stress/thallium study to assess whether you may have significant coronary artery disease already. About 25% of U.S. adults are in the high-risk category. Here is more on what to do if you are in the high risk category.

If you are in the intermediate risk group, you should should take aggressive steps to modify the risk factors keeping you out of the low risk category. Also, you should discuss with your doctor whether further testing should be done to characterize your risk more accurately. Such testing might include having your C-reactive protein (CRP) level measured, and perhaps getting a calcium scan.

 Roughly 40% of U.S. adults are in the intermediate risk category.

Again, if your doctor has not performed a formal cardiac risk assessment, you should estimate your risk yourself. And, if your risk appears to be intermediate or high, you need to talk to your doctor about taking aggressive measures to prevent heart disease.