THURSDAY, May 16 (HealthDay News) -- The tainted steroid injections linked to 55 recent U.S. deaths also caused many less lethal infections, more than half of them concentrated in Michigan, federal health officials reported Thursday.

Spinal meningitis deaths caused by contaminated back-pain treatments made the news for weeks last fall. But less attention was paid to a host of spinal or near-spinal infections without meningitis that were reported later in the outbreak. As of the first week of May, they had affected 320 people nationwide, with 52 percent of those cases in Michigan.

"Michigan has reported the highest percentage of cases even though we received only 13 percent of the contaminated drug that was shipped nationally," the report's co-author, Mawuli Nyaku, epidemic intelligence service officer at the U.S. Centers for Disease Control and Prevention, said Thursday.

The reasons for that disproportionate rate aren't clear, Nyaku said. Nor is it known if more cases will surface.

"We are not out of the woods yet," Nyaku said. "We have never seen anything like this before."

Because the time from injection to symptoms of illness isn't really known, more people who received the tainted drug may develop infections, Nyaku said. "Physicians are seeing patients who have developed infections 200 days after receipt of injection," he said. He urged doctors to consider the possibility of infection in anyone who received the epidural injections.

The infections -- whether leading to meningitis or not -- are caused by a fungus called Exserohilum rostratum (basically a common black mold) that contaminated vials of steroids produced by the now-shuttered New England Compounding Center in Massachusetts.

Since first reported last September, the outbreak has sickened 741 people in 20 states and killed 55. In Michigan, 261 people developed infections and 16 died, according to the report, which was published in the May 17 issue of the CDC's Morbidity and Mortality Weekly Report.

The localized infections, concentrated at or near the injection site, have led to abscesses, pain and some joint infections that necessitated joint replacement, Nyaku said.

These infections caught experts by surprise.

"We have known that the predominating organism was Exserohilum rostratum, which is a fungus," said Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center in New York City. "What we didn't know was that there were a series of spinal infections without meningitis."

Nyaku said one reason for the high number of cases in Michigan is that St. Joseph Mercy Hospital in Ann Arbor saw the most patients with the infection in the country. To help identify new cases, the hospital offered MRIs to anybody who had been exposed to the contaminated steroids. "In doing so they identified additional cases, which contributed to the high number," Nyaku said.

Another possible explanation, Nyaku said, is that more than 2,000 of the 17,000 vials of tainted drugs were shipped to Michigan. And one of the lots shipped to the state appeared to cause more infections than the other two contaminated lots, he said.

The black mold infections continue to bedevil investigators. No foolproof cure exists, and the drugs used to treat the infection are very expensive and can be toxic, he said. "When you put a patient on therapy, there isn't a guarantee that he is going to get better," Nyaku said.

Some patients who stopped therapy also have seen their illness return, he said.

More information

For more information on fungal infections, visit the U.S. Centers for Disease Control and Prevention.

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The drug, Xofigo, is targeted to patients with late-stage, metastatic disease that has spread to the bones but not to other organs, the FDA said in a news release. It is meant for patients who have already undergone surgery and/or drug therapies such as hormone-based treatments.

In a clinical trial involving more than 800 men with symptomatic prostate cancer that was resistant to hormonal therapy and had spread to the bones, men on Xofigo survived a median of 14 months compared to a little over 11 months for men taking a placebo. Side effects from Xofigo included nausea, diarrhea, vomiting and swelling of the legs and feet. Low levels of red and white blood cells, as well as platelets, were also reported among some patients taking Xofigo, the FDA said.

According to the American Cancer Society, prostate cancer remains the leading cancer type among men outside of skin cancer, and about one man in every six will develop the illness during his lifetime. Caught early, it is often curable. About 239,000 new cases of prostate cancer are diagnosed among American men each year, and nearly 30,000 men die from the disease annually.

Xofigo is co-marketed in the United States by Wayne, N.J.-based Bayer Pharmaceuticals and Algeta US, of Cambridge, Mass.

More information

The U.S. Centers for Disease Control and Prevention has more about prostate cancer

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THURSDAY, May 16 (HealthDay News) -- Men who are physically fit in middle age have a lower risk of developing and dying from certain cancers, new research indicates.

"Fitness is a huge predictor of [cancer] risk," said Dr. Susan Lakoski, an assistant professor of internal medicine at the University of Vermont, in Burlington. "You need to be fit to protect yourself against a cancer diagnosis in older age."

Men who were fit in their 40s, 50s and 60s were less likely decades later to get lung or colorectal cancer, she found. Those who were fit were also less likely to die from prostate, lung or colorectal cancers.

She is scheduled to present her research, supported by the U.S. National Cancer Institute, on June 2 at the American Society of Clinical Oncology annual meeting in Chicago.

While other studies have found physical activity protects against certain cancers, Lakoski said fewer studies have looked at the importance of fitness to predict whether men would develop or die from cancers.

For the study, Lakoski and her colleagues evaluated more than 17,000 men who had a single cardiovascular fitness assessment as part of a preventive health checkup at the Cooper Clinic, in Dallas, when they were 50, on average.

The men walked on a treadmill under a regimen of changing speed and incline. Their results were categorized into five groups, from lowest fitness level to highest.

Later on, the researchers analyzed Medicare claims data to identify the participants who had developed three common cancers among U.S. men -- lung, colorectal or prostate.

The average follow-up period was 20 to 25 years. During that time, 2,332 men developed prostate cancer, 276 developed colorectal cancer and 277 developed lung cancer.

During the follow up, 769 men died -- 347 of cancer, 159 of heart disease and 263 of other causes.

The men who were most fit on the treadmill test, when compared to the least, had a 68 percent lower risk of lung cancer and a 38 percent lower risk of colorectal cancer. Their prostate cancer risk didn't decline with increasing fitness, but the risk of death from it did.

Even a small improvement in fitness helped, the researchers found. For instance, a 50-year-old man who increased fitness so he could last three more minutes on the treadmill, Lakoski said, could reduce cancer death risk by 14 percent and heart disease death risk by 23 percent.

Low fitness levels increased the risk of cancer and heart disease even in men who weren't obese, the researchers found.

They also took into account other factors that could increase risk, such as age and smoking habits.

The good news, Lakoski said, is that, "You don't have to be highly fit to get protection." The most protection against cancer and heart disease was found in moving out of the least fit group.

And how unfit were those men? The men in the least fit group who were 40 to 49 when they took the test could walk on the treadmill less than 13.5 minutes. Those who were 50 to 59 lasted less than 11 minutes. Those 60 and older in the least fit group only lasted less than 7.5 minutes.

The findings make sense, said Colleen Doyle, director of nutrition and physical activity for the American Cancer Society.

"While you can't tell just how much activity these guys were doing over time, it makes sense that the most fit would have better cancer-related outcomes -- because they are likely the most active." While the new research did not find a link between fitness levels and a diagnosis of prostate cancer, a recent review of other published studies did show a modest reduction in that risk, Doyle said.

Lakoski can't explain the protective effects of fitness for sure, but can speculate. "We know that fitness modulates several important pathways also related to cancer risk," she said. These include, among other pathways, reducing inflammation and oxidative damage in the cells, she said.

Doyle agreed that many mechanisms are probably at work. Activity can improve immune function, for instance, and help control weight, and that in turn can decrease inflammation, she said.

To achieve cardiovascular fitness and reduce cancer risk, be moderately active 150 minutes a week or vigorously active for 75 minutes, or some combination, Doyle advised.

Because this study is being presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Lakoski found a link between fitness and cancer protection, not cause and effect. She also can't say whether the findings would apply to women. She hopes to study that next.

More information

To learn more about physical activity guidelines and cancer prevention, see the American Cancer Society.

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WEDNESDAY, May 15 (HealthDay News) -- Among young heart attack victims, women often have more medical issues, more chest pain and worse quality of life before the event than men, a new study reveals.

The researchers, from the Yale School of Medicine, said young women also tend to have worse mental health with more physical limitations prior to their heart attacks.

The findings could help explain why young women often have worse outcomes than their male peers after a heart attack, said the researchers, who concluded that doctors should regularly assess young women's heart attack risk.

"Compared with young men, women under 55 are less likely to have heart attacks," study author Rachel Dreyer, a research fellow in cardiovascular medicine at Yale, said in an American Heart Association news release. "But when they do occur, women are more likely to have medical problems, poorer physical and mental functioning, more chest pain and a poorer quality of life in the month leading up to their heart attack."

The study involved nearly 3,000 women and men, aged 18 to 55, who participated in an international study of heart attack patients. The researchers questioned the participants to assess their chest pain and quality of life before their heart attack.

The study also revealed that the women were more likely than the men to have other conditions linked to heart disease, such as diabetes: 40 percent of women compared to just 27 percent of the men. Moreover, 55 percent of the women were obese, compared to 48 percent of the men.

Of the women, 6 percent had a history of stroke and 6 percent had heart failure. In contrast, 3 percent of men had a history of stroke, and 2 percent had heart failure. Meanwhile, 13 percent of women had renal failure and 49 percent suffered from depression. The researchers said only 9 percent of men had renal failure and just 24 percent were depressed.

"These data suggest that young women were suffering more from their heart disease than young men prior to their heart attack," Dreyer said.

"We need to develop better methods for recognizing and treating young women with chest pain to optimize their quality of life and potentially even prevent a heart attack," Dreyer said in the news release.

"General health and disease-specific health-status assessments are valuable tools for health care providers to measure the burden of disease on patients," she said. "These should be standardized into clinical practice, much like assessments for other traditional heart disease risk factors."

The study findings were scheduled to be presented Wednesday at the American Heart Association annual meeting in Baltimore. The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. Centers for Disease Control and Prevention has more about women and heart disease.

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WEDNESDAY, May 15 (HealthDay News) -- People diagnosed with cancer are almost three times more likely to declare bankruptcy than are those without the disease, a large new study suggests.

And younger people with cancer have up to five times higher bankruptcy rates compared to older patients with the disease, the researchers found.

Of almost 200,000 people with cancer in the study based in Washington state, about 2 percent filed for bankruptcy protection after being diagnosed. Of those who were not diagnosed with cancer, 1 percent filed.

Although the risk of bankruptcy for those with cancer is still relatively low, researchers said it is significant.

"Bankruptcy is such an extreme measure of financial distress, and we didn't include the other forms of financial difficulties people encounter," said Catherine Fedorenko, a study co-author and technical project coordinator at the Fred Hutchinson Cancer Research Center, in Seattle.

Whether people suffer substantial debt or have to go so far as to declare bankruptcy, their financial problems are likely to be stressful, said Karma Kreizenbeck, a study co-author and project director at the Hutchinson Institute for Cancer Outcomes Research.

"This paper shows how medical debt associated with a cancer diagnosis could be more likely to lead to a bankruptcy," Kreizenbeck said. "But it could also mean people have to take second jobs, end up with lower credit scores or have to make other decisions."

Celeste Smith, 63, was diagnosed five years ago with breast cancer. A Seattle realtor who was just starting to do well in a new job, she found she had to stop working when she was faced with months of radiation and chemotherapy. Despite the fact that she had health insurance, her mortgage and car payment bills began to mount. "It's a horrible circle trying to get over cancer and deal with all the financial stress," she said. Smith ended up filing for bankruptcy and moving from her foreclosed house to affordable living for seniors.

Researchers have noted before that the financial burden on people with cancer can be substantial. Data from the Medical Expenditure Panel Survey in 2004 showed that 6.5 percent of the $20.1 billion spent on cancer care by those not yet on Medicare each year comes directly from the patients themselves, according to study background information.

A small study presented last year at an American Society of Clinical Oncology meeting showed that four of every five cancer patients and their spouses or caregivers said they had concerns about meeting medical costs and suffered associated financial and mental stress.

The new research, published online May 15 and in the June print issue of Health Affairs, is based on data taken from a registry of people 21 and older who lived in Washington and were diagnosed with cancer from 1995 through 2009. They were compared to a randomly sampled population of people without cancer, matched by age, gender and ZIP code. Cancer cases were identified using a cancer registry based at the Fred Hutchinson Cancer Research Center, part of a U.S. National Cancer Institute epidemiology database.

Key findings of the new study include the following:

• Cancer patients were 2.65 times more likely than people without cancer to go bankrupt.
• Those cancer patients who filed for bankruptcy were more likely to be younger, female and nonwhite than were cancer patients who didn't file. The youngest age groups had up to 10 times the bankruptcy rate compared to the older age groups. The youngest groups in the study were diagnosed at a time when their debt was typically high and their income was not, the study noted.
• Bankruptcy filings went up as time went by. While the proportion of cancer patients who filed for bankruptcy within one year of diagnosis was 0.52 percent, it went up to 1.7 percent after five years.
• Bankruptcy rates were highest for people with the diagnosis of thyroid and lung cancer, and lowest for melanoma, breast and prostate cancer. The authors suggested that the higher rate of bankruptcy associated with thyroid cancer was likely due to the fact that it affects younger women more often than do other cancers.

The study, based on data from 1995 to 2009, did not take into account the potential impact of the implementation of the Affordable Care Act (ACA) in 2010, an expert pointed out.

"The problem of bankruptcy was one thing the ACA was designed to address," said Peter Cunningham, a senior fellow and director of quantitative research at the Center for Studying Health System Change, in Washington, D.C.

Cunningham expressed concern that the researchers didn't note whether the cancer patients or the control participants had health insurance. "So we don't know how much of a difference having health insurance makes in terms of avoiding bankruptcy," he said. "It would have been nice to see what the impact of health insurance coverage is in being able to prevent bankruptcy and how many people lost their health insurance coverage because of their cancer diagnosis."

What should people do to avoid the stress of money troubles when faced with a serious disease? "The study points to the value of having health insurance," Cunningham said.

More information

Learn more about the cost of cancer treatment from the American Cancer Society.

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WEDNESDAY, May 15 (HealthDay News) -- The U.S. Food and Drug Administration announced Wednesday that it has approved a drug to help men with advanced prostate cancer whose disease has spread to the bones.

The drug, Xofigo, is targeted to patients with late-stage, metastatic disease that has spread to the bones but not to other organs, the FDA said in a news release. It is meant for patients who have already undergone surgery and/or drug therapies such as hormone-based treatments.

The FDA said Xofigo was approved more than three months ahead of the original August 2013 deadline the agency had set for a complete review. Instead, the drug was reviewed under the agency's "priority" review program, designated for medicines that appear safe and effective in a context where no good alternative therapy exists.

"Xofigo binds with minerals in the bone to deliver radiation directly to bone tumors, limiting the damage to the surrounding normal tissues," Dr. Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research, explained in the news release.

In a clinical trial involving more than 800 men with symptomatic prostate cancer that was resistant to hormonal therapy and had spread to the bones, men on Xofigo survived a median of 14 months compared to a little over 11 months for men taking a placebo. Side effects from Xofigo included nausea, diarrhea, vomiting and swelling of the legs and feet. Low levels of red and white blood cells, as well as platelets, were also reported among some patients taking Xofigo, the FDA said.

Pazdur noted that "Xofigo is the second prostate cancer drug approved by the FDA in the past year that demonstrates an ability to extend the survival of men with metastatic prostate cancer." The other drug, Xtandi, was approved by the FDA last August for men with hormone treatment-resistant prostate cancers that have spread or recurred, and who had previously been treated with the drug docetaxel.

According to the American Cancer Society, prostate cancer remains the leading cancer type among men outside of skin cancer, and about one man in every six will develop the illness during his lifetime. Caught early, it is often curable. About 239,000 new cases of prostate cancer are diagnosed among American men each year, and nearly 30,000 men die from the disease annually.

Xofigo is co-marketed in the US by Wayne, N.J.-based Bayer Pharmaceuticals and Algeta US of Cambridge, Mass.

More information

Find out more about prostate cancer at the U.S. National Cancer Institute.

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WEDNESDAY, May 15 (HealthDay News) -- If you're a man, the pain-killing medications known as opioids may do more than relieve pain -- they may also put a damper on your sex life.

A new study found that men who were prescribed medications for erectile dysfunction or low testosterone levels were more likely to be taking opioid (narcotic) medications for chronic back pain.

"People who have persistent pain problems need to know that a potential side effect of long-term opioid use may be erectile dysfunction," said lead study author Dr. Richard Deyo, a clinical investigator for the Kaiser Permanente Center for Health Research in Portland, Ore. "This is not a well-known potential side effect among patients, and it should be considered when thinking about treatment."

Deyo also noted, however, that "the nature of this study as an observational study limits our ability to make a causal [cause-and-effect] inference. Opioid use and erectile dysfunction seem to go together, but we have to be cautious about saying one causes the other."

Results of the study were published in the May issue of the journal Spine.

More than 4 million people use opioids on a regular basis, Deyo said. Commonly prescribed opioids include hydrocodone, oxycodone and morphine. In this study, use of opioids was considered long-term if patients used them for more than 120 days, or more than 90 days if more than 10 prescriptions were filled for the drugs.

The study included data on about 11,000 men who had back pain. In that group, more than 900 received medications for erectile dysfunction or testosterone replacement. Those who were given prescriptions for erectile dysfunction medications or testosterone were older than those who didn't get such prescriptions. They also were more likely to have depression and other health conditions.

And those who were taking erectile dysfunction medications or testosterone tended to be smokers or users of sedative medications, according to the study.

Erectile dysfunction drug prescriptions were for sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).

Age was the most significant factor in getting a prescription for erectile dysfunction, according to the study. Men between the ages of 60 and 69 were 14 times more likely to receive a prescription for an erectile dysfunction medication than men who were between 18 and 29.

After adjusting the data to account for other possible factors, including age, the researchers found that men who took opioid pain medications for long periods were about 50 percent more likely to take erectile dysfunction medications or testosterone replacement therapy.

Dr. Daniel Shoskes, a professor of urology at the Cleveland Clinic's Glickman Urological and Kidney Institute, said the study doesn't prove that the pain medications cause the erectile dysfunction.

"A direct association between long-term opioid use and [erectile dysfunction] has not been clearly defined," said Shoskes, who was not involved in the study. "The reason these men were having [erectile dysfunction] could be related to the pain or the things that are causing the pain. You can't conclude from this study that opioid use causes [erectile dysfunction]."

Study author Deyo said there's evidence that men who stop taking opioids after using them for a short time will see an improvement in erectile dysfunction, but he said it's not clear if the same is true after long-term use.

Deyo added that opioids can be effective for short-term use, but there's "growing evidence that long-term opioid use may not be effective for chronic pain. The body compensates for taking long-term pain medications, and changes in the brain and spinal cord may make people more sensitive over time."

Effective alternatives include a tailored exercise program and cognitive behavioral therapy designed to help reduce people's fear of pain, Deyo said.

Shoskes said other factors that contribute to erectile dysfunction include diabetes, heart disease, peripheral vascular disease and alcohol use. He said this study may prompt doctors who treat men with chronic pain to ask about erectile dysfunction, although he said it's not clear from this study whether the erectile medications were helpful for these men.

More information

Learn more about erectile dysfunction from the U.S. National Library of Medicine.

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SUNDAY, May 12 (HealthDay News) -- Twelve new genetic regions associated with an increased risk of testicular cancer have been identified by researchers in two studies.

One study identified four regions and the other identified eight regions, bringing to 17 the total number of genetic regions associated with testicular cancer. The studies were published online May 12 in the journal Nature Genetics.

Testicular cancer is the most common type of cancer diagnosed in young American men.

The findings could eventually help scientists better understand which men are at high risk and enable early detection or possibly even prevention of the disease, the researchers said.

The team, including Peter Kanetsky, an associate professor of biostatistics and epidemiology at the University of Pennsylvania Perelman School of Medicine, identified four of the 12 new genetic regions after analyzing the genomes of more than 13,000 men.

None of the four regions has been linked to other cancers. They pose a higher risk than other regions identified for some common cancers, such as breast and prostate cancer, according to a school news release.

Testicular cancer is highly inheritable. A man whose father or son has testicular cancer has a four to six times higher risk of developing the disease than a man with no family history. The risk is up to 10 times higher if the man also has a brother with testicular cancer.

More information

The American Cancer Society has more about testicular cancer.

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THURSDAY, May 9 (HealthDay News) -- About 13 percent of Americans 60 and older say they have increasing problems with thinking and memory and that they suffer growing confusion, a new report released Thursday shows.

One-third of these people add that the confusion or memory loss caused problems at work or with social activities and household chores, according to the U.S. Centers for Disease Control and Prevention.

The findings underscore the need to be alert for early signs of dementia or Alzheimer's disease, experts said.

"This is the first data of this kind," said report co-author Angela Deokar, a CDC public health advisor. In 2011, older adults from 21 states answered survey items on whether they'd suffered increased confusion or memory loss in the past year.

According to Deokar, signs to look out for include the following:

• Asking the same questions over and over again,
• Getting lost in familiar places,
• Not being able to follow directions,
• Becoming more confused about time, people and places.

These problems go beyond normal forgetfulness, Deokar said.

Since this is the first such report, it is not possible to see if there is an increasing trend or if these data are similar throughout the nation, she said. The survey is ongoing, however, so in a couple of years more information should be available.

The report was published in the May 10 issue of the CDC's Morbidity and Mortality Weekly Report.

People experiencing cognitive decline -- the gradual loss of the ability to think, reason and remember -- can face considerable challenges. Even so, only 35 percent of them have discussed the problem with their doctor, the researchers found.

Such conversations are important, because they make planning for the future easier as a person's mental health continues to decline, according to the report.

A dementia expert noted that these kinds of symptoms should be taken seriously.

People experiencing them "should have thorough medical exams to exclude treatable metabolic or cardiac diseases," said Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center, in New York City.

Report co-author Deokar noted that people with these symptoms can reach out to the aging services network, including agencies on aging and the Alzheimer's Association.

When causes of mental decline are identified early there is the opportunity to treat reversible causes, the report authors said. If the cause isn't reversible, as with Alzheimer's disease, there is more time to develop advance directives, to enroll in clinical trials and to plan for care needs.

More information

To learn about Alzheimer's disease, visit the Alzheimer's Association.

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WEDNESDAY, May 8 (HealthDay News) -- Some diseases are especially tough to discuss.

When Tony Lee realized that his penis was curving whenever he had an erection -- making it painful and difficult for him to have sex -- he had no idea what was wrong. He became depressed and very worried, and his relationship with his wife started to change.

"For a man to dread sex, it's just not natural," he said. "There were times when I would stay up late on purpose, just to make sure my wife was sleeping before I got into bed. I was just totally embarrassed."

His wife finally convinced him to see his primary care physician, who referred him to a urologist. The specialist told him he had Peyronie's disease, a connective tissue disorder involving the growth of fibrous collagen plaques in the soft tissue of the penis. The condition can cause pain, erectile dysfunction and shortening of the penis.

The diagnosis was difficult to face.

"You do freak out. It's such a personal area. It's like, 'Noooooo! Why couldn't I just lose a finger? Anything but this,'" said Lee, who is 46. Lee asked that his full name not be used.

Experts estimate Peyronie's disease, a connective tissue disorder, affects at least 5 percent of men. Although the cause of the disorder is not known, physicians think genetic predisposition and repetitive minor trauma to the penis during sexual activity may play a role. People with diabetes, and those who have had prostate cancer surgery or erectile dysfunction, are also susceptible to the disease, according to Dr. Larry Lipshultz, a professor of urology at Baylor College of Medicine.

The treatment options are very limited, and there is no cure. "There is no oral or topical medication," said Dr. Elizabeth Kavaler, a urologist at Lenox Hill Hospital, in New York City. "You can excise the plaque and tighten up the other side, but that reduces the length, or you can use a penile prosthesis."

Lipshultz said he's had some luck with about half of his patients when he gives them a drug called verapamil, a calcium channel blocker, which is injected into the shaft of the penis. The use of the drug is based on its ability to degrade collagen, slowing, preventing or even reversing plaque formation and the progression of Peyronie's disease, according to a 2002 study published in the International Journal of Impotence Research. A verapamil gel that is applied to the skin is also sometimes used, according to Kavaler.

Lee, who has been dealing with Peyronie's for about two years, has used a "straightening machine" that stretches the penis, and he participated in one of two clinical trials for a new drug that is up for review by the U.S. Food and Drug Administration: Xiaflex, produced by Auxilium Pharmaceuticals Inc. He said his penis is now 70 percent of its pre-disease length as a result of the interventions.

Xiaflex, which breaks down the scar tissue that is a component of penile plaque, was approved by the FDA in 2010 to treat Dupuytren's contracture, an inherited connective tissue disorder that causes the fingers to bend toward the palm. The concept of using Xiaflex with Peyronie's is based on some common features of both diseases. The hand condition is caused by an abnormal buildup of a substance called collagen. Fingers begin to bend toward the palm and the patient cannot straighten them.

The two clinical trials designed to test how Xiaflex worked in people with Peyronie's disease -- done in 2011 and 2012 -- together involved a total of 551 patients who received Xiaflex and 281 who were given a placebo. Each participant received four to six injections with a small needle into the penis every 25 to 72 hours over a period of several weeks. "The results showed people got a 30 percent improvement in curvature, which is clinically significant in terms of function," Lipshultz said

Recent data on the treatment appeared online in February and will be published in the July print issue of the Journal of Urology.

Lipshultz, who was involved in the clinical trials and is paid by Auxilium to speak to physicians about the treatment, said the company thinks Xiaflex will be approved by the FDA by mid-September.

Yet, Kavaler expressed concerns about whether Xiaflex will be helpful.

"The data show it looks like the drug made people feel better about their condition, maybe because they were getting treatment in the clinical trial, but I'm not sure if functionally it made a big difference," she said. "I don't think I could convince somebody to let me inject their penis four to six times with the hope of getting some small improvement."

Side effects from the injection of the drug included: bruising, swelling and pain. There were also three serious adverse events involving penile fracture and three hematomas, according to Auxilium Pharmaceuticals.

But Lee is hopeful.

"I was so far gone with this, the curvature was so bad, and so I feel a whole lot better about myself now," he said. "It's kind of like if a person was paralyzed, and then all of a sudden you can walk, even though you might need assistance, it's a wonderful thing. That's how I'm looking at it."

Lee encouraged people to involve their partners to help them deal with the disease. "If there is a significant other in your life, you guys need to come together with this. For me, that made all the difference."

More information

Learn more about Peyronie's disease from the U.S. National Library of Medicine.

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TUESDAY, May 7 (HealthDay News) -- Men who are uninsured or underinsured get advanced prostate cancer at nearly four times the national average and don't survive as long as other men with advanced disease, a new study says.

"We've identified a group of advanced prostate cancer patients who do not do well," said Dr. Jeffrey Reese, a clinical professor (affiliated) at Stanford University School of Medicine. He's also chief of urology at the Santa Clara Valley Medical Center, a county hospital serving a large underinsured population in San Jose, Calif.

"They come in invariably because they [are] having symptoms of metastatic disease," he said, which is when the cancer has spread to other parts of the body.

Of all men diagnosed with prostate cancer at the medical center from 1998 through 2008, Reese found 71 men, or more than 14 percent, had advanced prostate cancer. That's more than three times the national average of 4 percent who have advanced cancer at the time of diagnosis.

Even though the men were offered all available treatments, their five-year survival rate was also well below the national average, Reese found.

He is due to present the findings Tuesday at the annual meeting of the American Urological Association (AUA), in San Diego.

Testing for PSA measures the blood level of PSA, thought to be a key marker for prostate cancer. "A PSA of 4 is sort of the cutoff" before doctors begin doing other tests, Reese said. Some begin testing, such as a biopsy, even sooner, at 2.5 nanograms per milliliter (ng/mL).

In the study, the 71 men with advanced cancer all had prostate specific antigen (PSA) levels above 100 ng/mL. The median PSA in the men was nearly 400.

None of the 71 men -- whose average age was 66 -- had been tested for PSA before at the Santa Clara hospital, and Reese said he suspects most or all had never had a PSA test anywhere.

Under new, less stringent guidelines issued at the meeting, the AUA suggests PSA testing be discussed by men and their doctors, especially those aged 55 to 69, weighing the pros and cons of screening. The association says the best evidence of benefit from screening is among those men aged 55 to 69 screened every two to four years.

Survival of the men in the study was lower than the national average for men with advanced prostate cancer, Reese also found. The median survival was 18 months -- half of the men lived longer -- and less than 10 percent lived three years past the diagnosis.

In comparison, 29 percent of men with advanced disease, overall, live at least five years after diagnosis, Reese said.

Two factors predicted better survival among the 71 men, Reese said. Men under age 60 at diagnosis and those whose PSA declined to less than 1 ng/mL after treatment did better.

"The public hospital today gives you a snapshot of what it was like before PSA screenings," Reese said.

The study results do not surprise Dr. Scott Eggener, an associate professor of surgery at the University of Chicago. "Undoubtedly, a good portion of these men could have had their lives saved by PSA screening," he said.

"If you show up with a PSA of over 100, you have incurable prostate cancer," Eggener said.

This year, the American Cancer Society expects about 239,000 new cases of prostate cancer to be diagnosed in the United States and more than 29,000 deaths from the disease.

For those on Medicare, an annual PSA test is covered.

Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

More information

To learn more about prostate cancer, visit the American Cancer Society.

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TUESDAY, May 7 (HealthDay News) -- If you're a man suffering from low energy or libido, the drug industry is eager to help. So-called "Low T" -- low testosterone -- has become a common catch phrase in TV commercials, and sales of testosterone supplements are on the rise in the United States.

But a new study suggests that many clinics aren't disclosing the risks of testosterone treatment on their websites.

Researchers found that fewer than a third of 70 clinic websites mentioned the side effects of testosterone, although almost all touted potential benefits of treatment like improved sex drive and greater energy. Twenty-one percent, meanwhile, incorrectly denied that hormone treatment is linked to significant side effects.

Study co-author Dr. Kevin McVary, chairman of urology at Southern Illinois University School of Medicine, criticized the clinics that failed to be open about the risks of testosterone treatment. "It's unprofessional, and it reeks of snake oil," he said. "People should beware of using the Internet for medical advice regarding testosterone."

Testosterone, which is mainly produced in the testicles, is considered the male hormone (although it does occur in smaller quantities in women). Testosterone levels dip as men grow older. According to the Urology Care Foundation, researchers have found that about 20 percent of men over the age of 60 have low testosterone, which can lead to low libido, weak erections and fatigue.

Testosterone supplements are now available in a variety of forms, including injections, patches and gels that patients rub into the skin. The cost can run from $75 to $300 a month, said Dr. John Amory, a professor of medicine at the University of Washington in Seattle.

While testosterone treatment can indeed be beneficial, the side effects can include lower levels of healthy HDL cholesterol, increased male pattern baldness and possible harm to prostate health, Amory said.

Oral testosterone can lead to liver problems, study co-author McVary said, and testosterone overuse -- such as by some bodybuilders -- can lead to rage, acne, congestive heart failure and worsening of urinary symptoms.

In the new study, the researchers looked at the websites of 70 providers of testosterone supplements in Chicago, Houston, Los Angeles, New York City and Philadelphia. One-third were run by people who weren't physicians.

Only 27 percent described side effects of testosterone supplements, while 95 percent touted benefits. About a third of the sites run by urologists or endocrinologists described male breast growth as a potential risk. Seven percent of all the sites, however, denied breast growth as a potential side effect.

Amory said the new research appears to be valid and reflects "my impression of the way in which this [testosterone] is being oversold to patients."

McVary and Amory said they don't know if the clinics are acting legally when they omit information about testosterone risks. However, the U.S. Food and Drug Administration requires drug companies to describe the risks of prescription medications in their ads.

What to do? When it comes to medical information on the Internet, McVary said, "only go to legitimate sites that are sponsored by a medical organization that is known to you."

The findings were scheduled to be released Tuesday at the American Urological Association annual meeting in San Diego. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

For more about testosterone, try the U.S. National Library of Medicine.

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TUESDAY, May 7 (HealthDay News) -- Sleep problems may increase men's risk for prostate cancer, a new study suggests.

"Prostate cancer is one of the leading public health concerns for men, and sleep problems are quite common," said study author Dr. Lara Sigurdardottir, of the University of Iceland in Reykjavik. "If our results are confirmed with further studies, sleep may become a potential target for intervention to reduce the risk for prostate cancer."

Her study included about 2,100 men, aged 67 to 96, in Iceland. They were asked if they took medications to help them sleep, had trouble falling asleep or woke up during nights or early in the morning and had difficulty going back to sleep.

The researchers found that 14.4 percent of the men had severe or very severe sleep problems.

None of the men had prostate cancer at the start of the study. During five years of follow-up, 6.4 percent were diagnosed with prostate cancer, according to the study, which was published May 7 in the journal Cancer Epidemiology, Biomarkers & Prevention.

After adjusting for age, the researchers concluded that men with sleep problems were 1.6 to 2.1 times more likely to develop prostate cancer than those without sleep problems. Risk increased with the severity of sleeping problems.

The association was stronger for advanced prostate cancer than for overall prostate cancer. Those with very severe sleep problems had a more than threefold increased risk of advanced prostate cancer, the researchers found.

"Sleep problems are very common in modern society and can have adverse health consequences," Sigurdardottir said in a journal news release. "Women with sleep disruption have consistently been reported to be at an increased risk for breast cancer, but less is known about the potential role of sleep problems in prostate cancer."

She said these findings need to be confirmed in a larger and longer study.

Although the study found a potential association between sleep problems and prostate cancer, it did not prove a cause-and-effect relationship.

More information

The American Cancer Society has more about prostate cancer.

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MONDAY, May 6 (HealthDay News) -- Never mind the commercials with men talking freely to their doctor about their erectile dysfunction, taking a prescription for treatment to the pharmacy and settling in for a romantic evening.

Despite a wide range of treatment options, most men with erectile dysfunction (ED) don't get treated, according to a new study.

"ED treatments, overall, are underutilized," said Dr. Brian Helfand, an assistant clinical professor of urology at Northshore University Health System and the University of Chicago. "Only 25 percent of men are actually treated."

Helfand led the study, which looked at the medical records of more than 6 million men with an ED diagnosis. He is due to present his findings Monday at the American Urological Association annual meeting, in San Diego.

The study was funded by the Havana Day Dreamers Foundation (which promotes men's health), the Goldstein Fund in Male Pelvic Health and the SIU Urology Endowment Fund.

Helfand used an insurance claims database and looked for the medical code for erectile dysfunction from June 2010 through July 2011. He found 6.2 million men aged 30 and older who received a diagnosis of erectile dysfunction. ED is defined as an inability to maintain an erection satisfactory for sexual performance.

He then looked to see how many filled a prescription. Patients were considered treated if they filled a prescription for an erectile dysfunction drug such as Viagra (sildenafil) or Cialis (tadalafil), drugs called prostaglandins that are given by injection or urethral suppositories, or androgen (hormone) replacement.

He considered them untreated if they received a diagnosis of erectile dysfunction but did not fill a prescription.

He took into account, too, the men's ages and other health problems.

Even though erectile dysfunction is likely to become more common with age, he actually found older men the least likely to be treated. Only about 18 percent of men aged 65 and above were treated.

When Helfand looked to see what bearing other health conditions might have had on treatment, he found those with prostate cancer were least likely to be treated. Only 15 percent were.

The study didn't have information on why the men went untreated, he said. But he speculates there are probably several reasons.

The undertreatment, Helfand said, is probably a result of doctors often not offering the prescription or patients getting a prescription but not filling it at the pharmacy.

"Men may not be bothered by it," he said. Or a doctor may not write a prescription because he may not think the man is a candidate, or perhaps they didn't respond to erectile dysfunction treatment in the past.

Other reasons, he said, could include costs and embarrassment.

For men, Helfand said, the message is: "There are available therapies out there. These can be useful if you have ED."

An expert who reviewed the study but was not involved said he isn't sure if it mirrors real life.

"To conclude from this study that three-fourths of the men who carry a diagnosis of ED are not treated doesn't fit with what we see in clinical practice," said Dr. Jacob Rajfer, a professor of urology with the David Geffen School of Medicine, at the University of California, Los Angeles.

"In order to determine how many men were treated or not treated, you need to interview the people," Rajfer said.

Men might get to the pharmacy, see the cost of the erectile dysfunction drug, and decide to go out of the country to get it and save money, or might get it by mail order, Rajfer said.

Another expert discussed possible barriers to men getting these drugs.

"Cost might be a big issue," said Dr. Ajay Nangia, an associate professor of urology at the University of Kansas Medical Center. He is familiar with the study findings.

Costs vary, but some erectile dysfunction drugs are about $4 a pill.

"It's becoming much more open to talk about this stuff," Nangia said. Even so, some men may still be embarrassed.

In an effort to combat sales of counterfeit Viagra online, drugmaker Pfizer will sell the drug directly to patients with prescriptions via its website, the Associated Press reported Monday.

Because the new study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

To learn more about erectile dysfunction, visit the American Urological Association.

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MONDAY, May 6 (HealthDay News) -- Men with prostate cancer that has spread to other parts of their body are more likely to die after visiting an emergency department on the weekend rather than a weekday, a new study finds.

For the study, researchers at Henry Ford Hospital in Detroit looked at more than 15,000 of these so-called "metastatic" prostate cancer patients in the United States, who made emergency department visits between 2006 and 2009. The investigators found that 8.1 percent of those who made weekend emergency visits died, compared with 7.7 percent who made weekday visits.

After adjusting for age and the presence of other disease or disorders, the researchers concluded that patients who went to an emergency department on the weekend were 23 percent more likely to die after the visit than those who arrived on a weekday.

Compared to patients seen on weekdays, patients seen on weekends tended to be slightly older (average age of 75 versus 74) and healthier, with fewer other diseases or disorders.

About 14 percent of weekday patients versus 19.5 percent of weekend patients visited a non-metropolitan hospital, the study authors noted.

In addition, weekend patients were less likely to be suffering kidney failure (nearly 15 percent versus about 17 percent of weekday patients), and more likely to have blood in their urine (just under 19 percent versus just over 17 percent of weekday patients).

"Our data clearly show they have higher mortality rates after weekend visits to emergency departments," study lead author Dr. Khurshid Ghani said in a Henry Ford Health System news release. "But as to why, there is only a suggestion that they're more likely being treated at hospitals outside of metropolitan areas, places that may have limited access to advanced care."

Although the study found a higher death rate among metastatic prostate cancer patients who went to the emergency department on weekends versus weekdays, it did not prove a cause-and-effect relationship.

The study was scheduled for presentation Sunday at the annual meeting of the American Urological Association in San Diego. The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More information

The American Cancer Society has more about prostate cancer.

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FRIDAY, May 3 (HealthDay News) -- The number of testicular cancer cases continues to climb slowly but steadily in the United States, according to new research.

While the cancer is still most common among white males, the greatest increase is among Hispanic men, according to Dr. Scott Eggener, an associate professor of surgery at the University of Chicago.

Eggener tracked the statistics on testicular cancer from 1992 through 2009, looking at data from a nationwide epidemiology database.

"The incidence of testicular cancer appears to be increasing very slowly but steadily among virtually all groups that we studied," he said. "The novel finding is that the most dramatic increase is in Hispanic men."

Eggener can't explain the increase. He is due to present his findings Monday at the annual meeting of the American Urological Association, in San Diego. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases supported the study.

Testicular cancer is known as a young man's cancer, as half of the cases affect men aged 20 to 34, according to the American Cancer Society. However, older men can also be affected.

This year, the American Cancer Society expects 7,920 new cases of testicular cancer in the United States. About 370 men are expected to die of it.

"It still remains an uncommon cancer," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. He reviewed the new findings. "It's important that we become aware of the situation [of rising numbers of cases], but not become alarmed by it." Hispanic men, he noted, still have a lower rate of the cancer than do white men.

In his study, Eggener found that the incidence of testicular cancer rose from 1992 through 2009. In 1992, for instance, 5.7 of every 100,000 men had testicular cancer. By 2009, that number had risen to 6.8 men for every 100,000.

Hispanic men had the largest annual percentage increase. In 1992, four of every 100,000 Hispanic men were affected. By 2009, it was 6.3 men of every 100,000, the investigators found.

For men affected, the outlook is generally good, experts agreed. "It has the highest survival rate of any solid tumor," Eggener said. The overall five-year survival rate, he noted, is 95 percent or higher.

Symptoms can include a painless lump on a testicle, an enlarged testicle or an achy feeling in the lower belly.

Few risk factors have been identified. One known risk factor is having an undescended testicle -- one that does not move down into the scrotum at birth. In the United States, those born with an undescended testicle commonly have corrective surgery, Eggener said.

Currently, the U.S. Preventive Services Task Force, a national panel of experts, does not recommend routine testicular self-exams. It concludes that screenings performed by health care providers or men ''are unlikely to provide meaningful health benefits because of the low incidence and high survival rate of testicular cancer, even when it is detected at symptomatic stages."

Nor does the cancer society recommend routine monthly self-exams, Lichtenfeld said. "Clearly the task force has looked at this very carefully and they recommend not doing testicular self-exam or any form of screening for testicular cancer.''

According to the cancer society, testicular exam should be part of a routine exam by a health care provider, Lichtenfeld said.

It's important for men to pay attention to any changes in their testicles, he said.

"If a man notices a lump or a change, he should go see his doctor," Lichtenfeld said. "We have had a significant improvement in the treatment of this cancer."

More information

To learn more about testicular cancer, visit the American Cancer Society.

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FRIDAY, May 3 (HealthDay News) -- New guidelines from the nation's leading group of urologists on the controversial PSA test for prostate cancer highlight the importance of discussions between a man and his doctor.

Especially for men in their late 50s and 60s, the usefulness of the blood test may have to be decided on a case-by-case basis, according to new recommendations from the American Urological Association (AUA).

One expert called the new guidelines "a paradigm shift" in prostate cancer detection.

Dr. Louis Potter, chairman of radiation medicine at North Shore-LIJ Health System in New Hyde Park, N.Y., said the recommendations mark a move to more "personalized health management, where risk and age are balanced against the value of screening."

Prostate-specific antigen (PSA) screening is a test that measures the level of a key marker for prostate cancer in the blood. In general, the higher the level of this protein, the more likely it is that a man has prostate cancer, according to the U.S. National Cancer Institute.

The value of the PSA test has recently come into question, however, with several studies suggesting it causes men more harm than good -- spotting too many slow-growing tumors that, especially in older patients, may never lead to serious illness or death. In 2012, the U.S. Preventive Services Task Force, an influential government-appointed panel, advised against the routine use of the PSA test for prostate cancer.

The new AUA guidelines are more nuanced. The group does recommend against the PSA test for men under age 40 or for those aged 40 to 54 at average risk for prostate cancer.

The AUA says, however, that men aged 55 to 69 should talk to their doctors about the risks and benefits of PSA screening and make a decision based on their personal values and preferences.

Routine PSA screening is not recommended for men over age 70 or any man with less than a 10- to 15-year life expectancy.

The best evidence of benefit from PSA screening was among men aged 55 to 69 screened every two to four years. In this group, PSA testing was found to prevent one death a decade for every 1,000 men screened. But this benefit could be much greater over a lifetime, the guidelines noted.

The guidelines also said PSA screening could benefit men in other age groups who are at higher risk of prostate cancer due to factors such as race and family history. These men should discuss their risk with a doctor and assess the benefits and potential harms of PSA testing.

The new guideline updates the AUA's 2009 Best Practice Statement on Prostate-Specific Antigen and was announced at the association's annual meeting in San Diego on Friday.

"There is general agreement that early detection, including prostate-specific antigen screening, has played a part in decreasing mortality from prostate cancer," Dr. H. Ballentine Carter, who chaired the panel that developed the guidelines, said in an AUA news release.

There is more and better data about PSA screening available today than there was in 2009, so it is "time to reflect on how we screen men for prostate cancer and take a more selective approach in order to maximize benefit and minimize harms," Carter said.

One expert said the revised guidelines made sense.

"I think these guidelines are quite appropriate given the [slow-growing] nature of many prostate cancers," said Dr. Erik Goluboff, an attending urologist in the department of urologic oncology at Beth Israel Medical Center in New York City.

He agreed that discussions between a patient and his doctor on the PSA test are "extremely important."

"It has become increasingly evident that many, if not most, men diagnosed with early prostate cancer will never need treatment and can be spared the potentially devastating side effects of treatment such as urinary incontinence and erectile dysfunction," Goluboff said.

Some men, including black patients and patients with a family history of prostate cancer, may still decide to undergo PSA testing, he added. "This is in contrast to the U.S. Preventive Services Task Force, where a blanket statement that PSA screening is bad, regardless of individual patient risk, was made," Goluboff said.

A better test that pinpoints aggressive, life-threatening prostate tumors might be developed in the future, to better guide patients. "Hopefully, with discovery of better tumor markers, aggressive prostate cancers can be distinguished from [slow-growing] ones and only patients who need to will receive treatment," Goluboff said.

More information

The U.S. National Cancer Institute has more about prostate cancer screening.

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MONDAY, April 29 (HealthDay News) -- Men who are obese in their early 20s have a significantly increased risk of dying or of having serious health problems such as diabetes and heart disease by the time they reach age 55, a new long-term study indicates.

Researchers tracked the health of 6,500 Danish men from age 22 until age 55. At the start of the study, 83 percent of the young men had normal weight, 5 percent were underweight, 10 percent were overweight and 1.5 percent were obese.

By the end of the follow-up period, nearly half of the men who were obese at age 22 had been diagnosed with diabetes or high blood pressure, suffered a heart attack, stroke or blood clots in the legs or lungs, or had died.

Compared to those with normal weight, obese young men were eight times more likely to develop diabetes, four times more likely to have a potentially fatal blood clot, and more than twice as likely to develop high blood pressure, have had a heart attack or to have died, according to the study published April 29 in the online journal BMJ Open.

Every unit increase in body mass index (a measure of body fat based on height and weight) was associated with a 5 percent increased risk of heart attack, a 10 percent increased risk of high blood pressure and blood clots, and a 20 percent increased risk of diabetes.

Overall, obese young men had a nearly 50 percent risk of developing any of these serious health problems by middle age, compared with a 20 percent risk for young men with normal weight, according to a journal news release.

The findings suggest that rising rates of obesity may counteract the decrease in deaths from heart disease, and place a huge burden on health care systems worldwide, concluded study author Henrik Toft Sorensen, a professor at Aarhus University Hospital in Denmark, and colleagues.

The study found an association between obesity in young men and a greater risk of serious health problems or death by age 55. However, it did not prove a cause-and-effect relationship.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases outlines the health risks of being overweight.

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MONDAY, April 29 (HealthDay News) -- New guidelines from the U.S. Preventive Services Task Force call for virtually every adult to be routinely screened for HIV, the virus that causes AIDS.

The updated recommendations, which are published in the April 30 issue of the journal Annals of Internal Medicine, suggest that pregnant women and all people aged 15 to 65 be screened for HIV. The guidelines are now more in line with screening recommendations from the U.S. Centers for Disease Control and Prevention, the American College of Physicians and the American Academy of Pediatrics.

"HIV is a critical public health problem. There are 50,000 new infections in the U.S. each year, and we need to find ways to prevent and treat it," said guideline author Dr. Douglas Owens, a professor of medicine at Stanford University and a senior investigator at the VA Palo Alto Health Care System, in California.

The guidelines, last updated in 2005, reflect new evidence about the effectiveness of treatment, especially when started early in the course of HIV infection.

"The best way to reduce HIV-related death and disability is to avoid getting infected," Owens said. "Should someone become infected, we want them to understand that there are very good treatments that will help them live longer and reduce transmission."

Experts agreed that such blanket screening is the best -- and possibly only -- way to stop the HIV epidemic in its tracks.

Knowing one's HIV status is "a first step for both prevention and needed medical services, yet the history of the epidemic has set up barriers such that, in some states, it is still not straightforward to access an HIV test without the need for written consent or a fee," said Dr. Sten Vermund, director of the Institute for Global Health at Vanderbilt University School of Medicine in Nashville. "Free, regular screening for HIV, much as we try to have regular blood pressure or breast cancer screening, is one of the best ways to start reducing the HIV epidemic in the U.S."

Another expert agreed.

"There is a growing -- and overdue -- realization that treating HIV infection has both a personal and public health benefit," said Dr. Paul Volberding, a professor of medicine at the University of California, San Francisco School of Medicine. He wrote an editorial accompanying the guidelines.

"We may have a chance to end the AIDS epidemic, but that all begins with diagnosing infection in the estimated 20 percent of cases in the U.S. [who are] unaware of their status and thus not in medical care," he said. "Finding infected persons, bringing them into care, suppressing their HIV levels and retaining them in that state are the overriding goals of HIV control. These guidelines, along with those of the CDC, can help in the first step in that care cascade."

"HIV therapy is the most effective means of preventing all forms of transmission," Volberding said. "The importance of treatment as prevention was underscored by the very recent failure of the only candidate HIV vaccine in large clinical trials. We may well have to treat our way out of the epidemic, and that process begins with diagnosis and ends with lifelong engagement in care."

More information

Learn more about risks for HIV transmission at the U.S. Centers for Disease Control and Prevention.

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MONDAY, April 29 (HealthDay News) -- Men with deep voices and women with high voices are judged more attractive by listeners of the opposite sex because they estimate the speaker's body size by their voice, a new study shows.

Men in the study preferred recordings of women's voices with features that indicated a smaller body size, such as high pitch and breathy sound. Women preferred men's voices with low pitch and other features that indicated a large body size.

But women also liked men's voices that were breathy, which presumably softened the aggressiveness typically associated with a larger body size, according to Yi Xu, from University College London in the United Kingdom, and colleagues.

The findings were published recently in the journal PLoS ONE.

Previous studies of animals and birds found that listeners can perceive a caller's body size and intention based on voice features. For example, low-frequency growls are more likely to indicate a larger body size, dominance or a potential attack, while higher frequency sounds suggest smaller body size, fear and submissiveness.

The new study shows that, despite the development of complex language, human vocal interactions still use certain animal instincts, the researchers said.

More information

The U.S. National Institute on Deafness and Other Communication Disorders explains how to take care of your voice.

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