The United States Preventive Services Task Force issued their final recommendation on the PSA prostate cancer-screening test Monday, recommending against routine PSA exams for men of any age. The task force says the PSA exam and additional treatments that may follow, like radiation and surgery, result in far more harm than benefit. Dr. Virginia Moyer, who sits on the task force, cited that only one out of every 1,000 men who are screened would actually benefit from the exam. Instead, most will have to deal with side effects from treatment that can range from incontinence and impotence, to stroke and death. “Your primary care physician shouldn’t routinely offer the exam," said Moyer. "But if a patient brings it up, that doctor has a responsibility to inform them of the potential harms and risk." However, the American Urological Association is not changing its stance on the PSA test.  “We at the AUA still recommend the PSA, with its imperfections," said Dr. Chris Amling. "It’s the wrong thing to deny a man if he wants to have this test." Related: Value of mass prostate cancer screenings questioned The PSA test measures the amount of prostate-specific antigens in the blood. While the screening detects the presence of prostate cancer, it cannot make the distinction between aggressive, fast moving cancers, and the more common slow growing ones. “There is no other screening test for prostate cancer. It’s clear that the only way to cure prostate is to detect it early," Amling emphasized. Related story: Annual prostate cancer test doesn't save lives, study says According to the American Cancer Society , prostate cancer is the second deadliest cancer among men, and occurs most often in African-American.  But survival rates also are very high. The American Cancer Society finds that 91% of all men with prostate cancer will live for 15 years beyond diagnosis. According to the National Cancer Institute , 70% of prostate cancer deaths occur after age 75. Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society supports the recommendation of the task force.  “People need to realize that science hasn’t given us the answer," said Brawley. "In the past, when we don’t have a scientific answer, and we’ve guessed, we’ve hurt a lot of people." Related story: Who decides about screenings? The task force made its draft recommendation publicly available in October 2011 , and reviewed nearly 3,000 comments before issuing its final recommendation. Filed under: Cancer , Men’s Health Tagged: Nadia Kounang – CNN Medical Producer

The Centers for Disease and Prevention released their annual health report for 2011 on Wednesday. The report contains more than 150 data tables on the U.S. population's well-being, with a special focus on socioeconomic status. Here are a few of the interesting tidbits we found. For more, visit www.cdc.gov . The Bible Belt needs more doctors. On average, there were 25 physicians for every 10,000 people in the U.S. in 2009. The Northeast, Hawaii and Minnesota had the highest ratio of doctors to patients, while states in the South and Rocky Mountain-areas had fewer than 21 per 10,000. Your education level affects your kids' weight. The CDC collected data on childhood obesity between 2007 and 2010. Where the head of the household had a college degree, 7 to 11% of children aged 2 to 19 were obese. But when the head of the household was a high school dropout, 22 to 24% of the children were obese. Cigarette smoking is still on the decline. In 2010, 19% of U.S. adults smoked, down 2% from 2009. Over the last decade cigarette smoking among students in 12th grade has decreased from 33% to 22% for male students and from 30% to 16% for female students. Fewer teens are giving birth. Between 1998 and 2008, birth rates declined 27% for teenagers between the ages of 15 and 17. The gap is widening in education… In 2006, men without a high school diploma were expected to live 9.3 years less than those with a Bachelor's degree. The difference is two years more than it was in 1996. A similar gap increase holds true for women. … and narrowing in racial disparities. While the gap between life expectancy rates for African Americans and whites still exists, the gap has narrowed over the last two decades. Hispanics still have higher life expectancies than both ethnic groups. We're getting better at getting check-ups. In 2010, 59% of people over the age of 50 underwent a recent colorectal test or procedure, compared to 34% in 2000. Heart disease is still the No 1. killer. In 2008, 617,000 people died from heart disease-related causes. The prevalence among adult men and women has remained fairly steady for the last decade. Our children are fat, but not getting fatter. In 2010, approximately one in every five children was obese. Yet that rate has stayed pretty steady since 2007. That year, 19.6% of children aged 6 to 11 were obese. In 2010, it was 18%. Most people aren't moving enough. In 2010 more than half of American adults failed to meet the government's recommended daily physical activity levels. It was worse for the elderly – approximately 70% of those over 75 didn't meet the requirements. Filed under: Adolescent Health , Cancer , CDC , Children’s Health , Living Well , Men’s Health , Obesity , Smoking , Women’s Health Tagged: Jacque Wilson — CNN.com writer/producer

NEW YORK (CBSMiami) – It’s home to the Happiest Place on Earth, but maybe not for the reason you’re thinking of. The city the world knows for Cinderella and Shamu, for fairy castles, Hollywood dreams and african lions now has a new reason for fame; Men’s Health magazine has named Orlando the smuttiest city in America. Chances are Walt Disney is rolling over in his grave at the news that the city known for the great American family vacation is now being associated with more adult entertainment and more private pleasures. Orlando ranked in first place when Mens Health Magazine surveyed cities for the enjoyment of porn. They got real scientific about it.They tracked porn DVDs rented, sold, or streamed on the internet. They counted the number of adult entertainment stores. They even checked subscribers to soft-core porn king Cinemax and checked Google searches for porn. Imagine getting that assignment. Imagine your surprise when it led you to wholesome Orlando. Now, if Miami had made the top of the list it would surprise no-one. The iconic porn movie Deep Throat was filmed in Coconut Grove; in fact, the home where it was filmed is up for sale now. A few million and you could live in Porn Central. The city is also home to a host of production companies, large and small, that crank out everything from the rankest amateur porn to slick productions, rivaling the west-coast porn industry headquartered in LA. But Men’s Health wasn’t interested in production, only consumption, and based on that sexy South Florida could only manage to slide in at 12th place. Behind, believe it or not, Boise, Idaho. Even Tampa was pornier than Miami, making it in at 8th place. But of the top 100 smuttiest cities, only Jacksonville (52) and St. Petersburg (60) joined us on the list. Because you know you want to know if your hometown is on the list, here’s the full 100 cities from Mens Health, and the link to the full article http://www.menshealth.com/health/smut-census 1. Orlando, FL 2. Las Vegas, NV 3. Wilmington, DE 4. Raleigh, NC 5. Charlotte, NC 6. Minneapolis, MN 7. Atlanta, GA 8. Tampa, FL 9. Anchorage, AK 10. Austin, TX 11. Boise, ID 12. Miami, FL 13. Houston, TX 14. Columbia, SC 15. Dallas, TX 16. Portland, OR 17. San Diego, CA 18. Cleveland, OH 19. Sacramento, CA 20. Baltimore, MD 21. Providence, RI 22. Durham, NC 23. San Francisco, CA 24. Wichita, KS 25. Columbus, OH 26. Plano, TX 27. Manchester, NH 28. Jersey City, NJ 29. St. Paul, MN 30. Madison, WI 31. Cheyenne, WY 32. Denver, CO 33. Chicago, IL 34. Philadelphia, PA 35. Rochester, NY 36. Tucson, AZ 37. Reno, NV 38. Riverside, CA 39. Bakersfield, CA 40. New Orleans, LA 41. Omaha, NE 42. Seattle, WA 43. Milwaukee, WI 44. Greensboro, NC 45. Fort Worth, TX 46. Oklahoma City, OK 47. Pittsburgh, PA 48. Colorado Springs, CO 49. Nashville, TN 50. Phoenix, AZ 51. Honolulu, HI 52. Jacksonville, FL 53. Anaheim, CA 54. Tulsa, OK 55. Aurora, CO 56. Lexington, KY 57. Bridgeport, CT 58. Buffalo, NY 59. Portland, ME 60. St. Petersburg, FL 61. San Jose, CA 62. Billings, MT 63. Virginia Beach, VA 64. Albuquerque, NM 65. St. Louis, MO 66. Kansas City, MO 67. Fresno, CA 68. Sioux Falls, SD 69. Los Angeles, CA 70. Louisville, KY 71. Salt Lake City, UT 72. Stockton, CA 73. San Antonio, TX 74. Little Rock, AR 75. Memphis, TN 76. New York, NY 77. Corpus Christi, TX 78. Indianapolis, IN 79. Oakland, CA 80. Washington, DC 81. Cincinnati, OH 82. Birmingham, AL 83. Boston, MA 84. Burlington, VT 85. Des Moines, IA 86. Detroit, MI 87. Fort Wayne, IN 88. Chesapeake, VA 89. Newark, NJ 90. El Paso, TX 91. Norfolk, VA 92. Fargo, ND 93. Lincoln, NE 94. Toledo, OH 95. Laredo, TX 96. Lubbock, TX 97. Charleston, WV 98. Winston-Salem, NC 99. Baton Rouge, LA 100. Jackson, MS

Ian Kerner , a sexuality counselor and New York Times best-selling author, blogs about sex weekly on The Chart. Read more from him on his website, GoodInBed. Given the ease with which the average person can rattle off brand names like “Viagra” and “Cialis,” or joke about “four hour erections,” it would seem that erectile-dysfunction drugs are just about as common as ibuprofen. We take it for granted, but the little blue pill has drastically changed the way we think about erectile disorder (ED). Once known as “impotence,” ED was originally thought to be caused by anxiety, nerves, or low self-esteem; now it’s commonly known to be a health issue that hinges on the flow of blood to the penis and taking a pill to deal with the issue is often no big deal. Don’t get me wrong: this is not to say that Viagra and its brethren – Levitra, Cialis and the new FDA-approved Stendra – are the be-all end-all, or even that they’re unequivocally effective. It’s just that these medications have helped to spur a national dialogue (and often a debate ) that has changed the way we think about sexual problems . But now that ED has come out of the shadows, what about the other major male sexual issue — premature ejaculation (PE)? As I discussed in an earlier column , PE, (the inability to maintain intercourse for more than a minute without ejaculating) is known to affect up to a third of all men, making it even more prevalent than ED. And yet we tend to think about PE in much the same way we once thought about erectile disroder – shrouded in myth. Most still think of PE as a function of psychology or behavioral conditioning, rather than physiology and neurochemistry. For example, many wrongly assume that: PE only affects young men who are sexually selfish or immature it's the result of early masturbation habits it hints at deeper, psychological issues But in my professional work, I’ve observed that men who struggle with PE don’t do anything differently than men who don’t have the problem. They don’t masturbate differently; they don’t have different psychological issues; they don’t approach sex differently. Much like a predisposition toward right-handedness, premature ejaculators are often just born that way. Fortunately, PE is increasingly recognized as a health issue, and this is a relief to those men who struggle with it and can’t help but ask themselves: What’s wrong with me? As with the little blue pill, the pharmaceutical industry has been on the hunt for a PE drug. Just as the discovery of Viagra was somewhat of an accident (its erectile-enhancing qualities were only discovered after the drug was being developed as a potential heart medication), it’s been observed that certain SSRI-based medications can delay ejaculation. Ironically, what is a sexual side-effect to many may actually be a sexual boon to the man who suffers from PE, and so some doctors will prescribe the off-label use of an SSRI to help manage the condition. One drug – Priligy – is a short-acting selective serotonin reuptake inhibitor that is being marketed in parts of Europe as a premature ejaculation pill, but it has not yet received FDA approval here in the U.S.. Another medication potentially awaiting FDA approval is PSD502 , a topical numbing agent that can be applied to the penis to decrease penile sensitivity. The use of such numbing agents as a treatment for PE dates back to 1943, but these products have had their limitations. For one thing, it’s been difficult to establish a recommended dosage. For another, these topical solutions need to be applied at least 20 to 30 minutes before intercourse in order to be effective. Additionally, if numbing agents are being used, the man may be required to use a condom to ensure that his partner’s genital area does not also become numb. While helping to diminish penile sensitivity, a numbing agent does not address a man’s “ejaculatory trigger” which is neurochemically activated. Still, those behind PSD502 claim to have developed a formula that doesn’t suffer from many of these drawbacks. Like Priligy, PSD502 is not yet available, but a very similar product has been FDA-approved based on a pre-existing monograph. Dubbed Promescent , this product carries many of the same benefits of PSD502 and effectively decreases penile sensitivity without transmitting any numbness to a man’s partner. But as helpful as a product like Promescent can be, I still counsel men to focus first on partner-communication, as well as “sex scripts” that de-emphasize intercourse while vouchsafing female pleasure – both of which I discuss exhaustively in my e-book, “ Overcoming Premature Ejaculation .” From there, many men who suffer from PE may find that they still need to pursue a broader “biopsychosocial” approach: one that combines behavioral, medical, and interpersonal approaches. In the absence of a single “silver bullet” to do away with PE, it’s often necessary to do a little bit of everything. Let’s not wait for the next blockbuster drug to arrive in order to have a meaningful, well-informed conversation about PE. It may never come, but the conversation should. Filed under: Men’s Health , Sex Tagged: Ian Kerner Ph.D. – sex counselor

Look out Viagra – there's a new erectile dysfunction drug in town. It's called Stendra (aka Avanafil) and it's newly approved by the Food and Drug Administration, making it the first ED drug to come out in almost 10 years. Although Stendra has not been tested against what is known as the "Little Blue Pill," drug makers say that – for some men – it may work faster. "If things are heated up, theoretically you can get improved function earlier, within 15 minutes, with this drug," said Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego, and co-author of a recent study about Stendra in the Journal of Sexual Medicine. "You can argue this is the first potential on-demand drug." The "on-demand" drug could end up in high demand for men with ED who do not respond to drugs like Viagra, Cialis and Levitra. Goldstein, who has authored more than 300 studies in the field of sexual dysfunction, said that early data suggests Stendra may perform faster than other ED drugs, but that must be proven in a larger, real-world population. Goldstein and his team studied 1,267 men who took a 50, 100 or 200 milligram dose of Stendra – or placebo – about 30 minutes before engaging in sexual activity. The men filled out questionnaires indicating, for example, how long it took before they engaged in sexual intercourse or became aroused. "For some men it works in 15 minutes, for some men it took longer," said Goldstein. To be clear, no one is suggesting that men should drop Viagra – or any other of the popular ED drugs– for Stendra. "There is no drug that is the best," said Dr. Laurence Levine, a professor in the department of Urology at Rush University Medical Center in Chicago, who was not a part of the Stendra study. "Each patient's own chemistry may make one drug better than another. There are certain advantages and disadvantages to all of these drugs." Stendra is another option in a field of effective and safe drugs, said Levine. A small minority of patients experienced side effects after taking Stendra, according to the study, including headaches, flushing, nasal congestion and back pain. And overall, patients taking any ED drug – all of which work similarly – should be aware of rare side effects like sudden loss of vision or hearing, according to the FDA. Filed under: Men’s Health , Senior Health , Sex Tagged: Stephanie Smith -CNN Medical Producer

Programming note:   This weekend on " Sanjay Gupta MD ," Dr. Gupta takes a critical look at sugar and the impact it has on our bodies. Don't miss the in-depth investigation Saturday at 4:30 p.m. ET, and Sunday at 7:30 a.m. ET, on CNN. Sweet tooth? You’re not alone. Sugary foods and beverages are delicious. But we’ve also learned they can be highly addictive and, too much of them, can take a serious toll on our health. Today some of our favorite drinks, gum, baked goods, and candy are available in sugar-free versions. But that got me thinking…  are sugar substitutes any better for you than the real thing? I was not alone on this issue. I’ve received dozens of tweets and emails wondering if fake sugar can harm us, or worse, crave more food! For some answers I turned to internist and physician nutrition specialist, Dr. Melina Jampolis . Her specialty is practiced by only 200 physicians in the United States. She focuses exclusively on nutrition for weight loss and disease prevention and treatment. CNN: First of all – are all sugar substitutes pretty much the same? Dr. Jampolis: It is important to understand that there are both natural and artificial substitutes. Most of the concerns people have are around the five FDA-approved artificial sweeteners: Acesulfame potassium (Sunett, Sweet One), Aspartame (Equal, NutraSweet), Neotame, Saccharin (SugarTwin, Sweet'N Low), and Sucralose (Splenda). But it is important to point out that these sweeteners are all different. They all have different chemical make-ups and they are handled differently in the body – some are completely broken down, some are not. So you can’t just lump them into one thing if you do have concerns about them. CNN: How are natural sweeteners – like stevia – different? And are they a healthier option compared to artificial sweeteners? Dr. Jampolis:  Stevia is a natural sweetener from South America that has no calories but is 250 times sweeter than sugar.  It has seen a huge surge in popularity since its clearance as GRAS (generally regarded as safe) as a food additive in 2008.  Stevia has been proven safe and effective by the FDA. Many nutrition experts prefer it since it is natural, but just because something is natural does not always mean that it is safer. I tell my patients that if you prefer the taste of a natural sweetener, then I think it is a very good option but there isn’t evidence that it is a healthier option compared to artificial sweeteners. CNN: There is always a lot of buzz linking sugar substitutes and cancer. Is there any reason for people to be worried? Dr. Jampolis: The studies that I have seen, and the studies the National Cancer Institute have reviewed, all point to the fact that in humans there is no compelling evidence. It is really more of just a few animal studies. In the 1960s there was a study of saccharin in rats, which found an increase in bladder cancer and caused a great deal of fear. However, it was later found that the mechanism by which it caused cancer in rats was not even possible in humans. Animal studies do not always reflect human response and saccharin is a great example of this. Aspartame is also often anecdotally linked to brain disorders based on small animal studies, but human studies have not shown an association. I think that at this point, we don’t have convincing research. It is more hype and really just a little bit blown out of proportion. CNN: I’ve also heard that sugar-free foods and drinks can make you crave more food and calories. It sort of tricks your body. Any truth to that? Dr. Jampolis: This is an interesting question which has not been answered definitely.  The taste of sweet does cause the release of insulin, which lowers blood sugar , and if carbohydrates are not consumed,  it causes a drop in blood sugar which triggers hunger and cravings for sugar.  So if an artificial sweetener is consumed alone, it could theoretically increase hunger.  However in the context of a meal, it is not known if it causes an increase in hunger and if so, it's not known if this outweighs the decrease in calories consumed. We know that some artificial sweeteners do cause a release of insulin which could drop your blood sugar and make you crave more sugar actually. And they also seem to trigger the same addition like pathways in the brain. CNN: Okay – so would I be better off eating one small piece of candy made with real sugar, or a larger portion that is sugar-free? Dr. Jampolis: Honestly I don’t think there is a correct answer.  In my opinion, if you consume it after a meal (not on an empty stomach), I would go by preference.  If you really enjoy a piece of chocolate with real sugar, having a small amount is fine. If you like the taste of sugar-free cherry candy, that’s OK.  As long as we consume things in moderation, I don’t think either option is harmful. When we start talking about beverages (soda versus diet soda) it becomes more of an issue. Sugar-sweetened beverages can contribute hundreds of extra calories to the diet that we don’t fully compensate for. And many experts, including myself, feel that it significantly contributes to weight gain, especially metabolically toxic weight gain and metabolic abnormalities. CNN: I remember a study a few years back that found people who drink diet soda tend to weigh more than people who don’t.  Why do you think that is? Dr. Jampolis:  A lot of studies show that diet soda is linked with being overweight but there isn’t a clear answer as to why. Is it because they drink diet soda that they are overweight? Or is it because it actually causes weight gain? We all know people who drink diet sodas all day long, but then go home in the evening and have a large serving of ice cream. However, there is some evidence suggesting an increased risk of metabolic syndrome with diet soda intake. So I think the best advice is probably to limit both regular and diet soda consumption for optimal health, especially with children. CNN: Bottom line: if I want to cut down my sugar consumption, are sugar substitutes a safe option for me? Dr. Jampolis:   I don’t think that they are a good idea for children since we don’t fully understand the potential metabolic/programming effects. If there is even the possibility of an increased risk of any disease, a lifetime of exposure would increase that risk. In adults, I think they can be safely consumed in moderation if you are diabetic and are trying to reduce sugar and/or trying to lose weight and reducing caloric intake as they help reduce the calorie density of foods – which is one of the most important components of permanent weight loss. If you feel like you are dependent on sugar, I suggest limiting consumption, particularly in beverages, as the high intensity of their sweetness could contribute to dependency. In general, I like to see people trying to decrease the overall sweetness of their diet over time – adding fresh fruit to water instead of sugar-sweetened beverages or substituting things like applesauce for some of the sugar in baked goods can boost nutrients while reducing calories and sugar. I don’t recommend using "healthier-sounding" alternatives to sugar – like honey – unless you prefer the taste, as they contain the same amount of sugar as table sugar. Filed under: Addiction , Food Safety , Healthy Eating , Longevity , Men’s Health , Nutrition , Obesity , Weight loss , Women’s Health Tagged: Danielle Dellorto – CNN Medical Senior Producer

The Empowered Patient is a regular feature from CNN Senior Medical News Correspondent Elizabeth Cohen that helps put you in the driver's seat when it comes to health care. Hollywood producer and television legend Dick Clark died of a heart attack a day after having prostate surgery, according to a death certificate obtained by CNN. Clark died last Wednesday at St. John’s Health Center in Santa Monica, California. The day before his death, he had an operation to relieve “acute urinary retention,” an inability to urinate. “It’s a very painful condition,” says Dr. Kevin McVary, professor of urology at Northwestern University’s Feinberg School of Medicine in Chicago. The operation is “exceedingly safe” according to McVary, a spokesman with the American Urological Association. “The mortality rate is less than one in 1,000. That’s very low risk,” he says. The death certificate lists acute myocardial infarction and coronary artery disease as the causes of death. In December 2004, Clark suffered what was then described as "a mild stroke," just months after announcing he had been diagnosed with Type 2 diabetes. Patients with this kind of health history are usually screened by a doctor to test whether their heart is strong enough to withstand surgery, McVary says. The surgery, known as transurethral resection of the prostate , is considered lower risk because it doesn’t involve an external incision. Instead, doctors insert a surgical tool through the tip of the penis and into the urethra, and then cut away prostate tissue to unblock the flow of urine. It’s not known why Clark had a heart attack after this procedure. Surgery can be risky for cardiac patients. Anesthesia, for example, can be difficult on the heart, and so can blood pressure fluctuations that occur during surgery. “Having surgery is a stressful event,” says Dr. Kenneth Rosenfield, an interventional cardiologist at Massachusetts General Hospital in Boston. “It might have been enough to tip him over.” Filed under: Heart , Men’s Health , Surgical Procedures Tagged: Elizabeth Cohen – CNN Senior Medical Correspondent , John Bonifield – CNN Medical Producer

Anthony Youn, M.D., is a plastic surgeon in metro Detroit. He is the author of  “In Stitches,”  a humorous memoir about his Match Day and becoming a doctor. The pair of double-Ds jutting out in front of me look like they would belong on Pam Anderson. Instead they’re attached to a 14-year-old boy. I whip out a black marker and start drawing on Phil, my first surgery patient of the day.  Phil has severe gynecomastia, or enlarged male breasts. Phil was brought to me by his grandmother, who raised him since he was ten.  Apparently he was a well-behaved kid and good student until puberty hit.  Like most maturing boys his voice deepened and his height increased. Unlike most other boys, however, he began to sprout breasts. His breasts grew and grew until they drooped down to the middle of his abdomen. Phil’s grandmother noticed him becoming more and more withdrawn.  His friends abandoned him.  Kids taunted him.  His grades suffered.  He even failed physical education after refusing to take his shirt off.  Phil’s grandmother decided to take control of the situation and made an appointment for Phil to see me. At the consultation, Phil was mostly quiet.  He let his grandmother do the talking.  Then, at the end of the appointment his sad eyes stared into mine.  With a quivering voice he asked, “Can you help me?” “Yes,” I replied, with as much confidence as I could muster. Three weeks later, here we are. — Phil is part of a new trend in plastic surgery.  More and more men are signing up to have work done.  According to the American Society for Aesthetic Plastic Surgery , in 2011 more than 800,000 men underwent cosmetic procedures, an increase of 121% since 1997.  Gynecomastia reduction, one of the most popular surgeries, was performed on nearly 18,000 men.  Botox was the most common procedure overall, with over 260,000 men undergoing injections in 2011. Possibly the biggest factor influencing the rise in male plastic surgery is improvement in techniques, devices and products.  Looking refreshed and rejuvenated has never been so easy.  Gone are the days when patients had to deal with lengthy scars and a ‘wind tunnel’ appearance.  Bags under the eyes and bumps on the nose can now be removed with no visible scars.  Injectables like Botox and Restylane can  reduce wrinkles while avoiding the knife.  And new laser treatments can smooth the skin without any downtime at all. Still, cautionary tales remain.  Because most plastic surgery procedures were developed with the female face and figure in mind, they must be performed differently on men.  Otherwise male patients can be left looking feminized and unnatural.  One look at Kenny Rogers, who famously admitted to having undergone botched upper eyelid surgery back in 2006, will confirm this risk.  He gambled with plastic surgery and lost. So what about Phil? — Phil’s surgery goes well.   I lop off his breasts with a scalpel, cut off the nipples and suture them back onto his now flat chest as skin grafts.  The whole procedure takes 90 minutes. Eight pounds of breast tissue lighter, we sit him up on the operating room table.  His chest has gone from massive and saggy to flat and tight.  His areolas have decreased in diameter from the size of pie plates to quarters. Three months later Phil and his grandma see me for his final postoperative visit.  His demeanor has changed from sad and withdrawn to friendly and energetic.  It’s as if a cloud over his world was lifted.  As he walks out of the exam room, he stops and gives me a big, devilish grin. Then he says something that makes my day. “Dr. Youn, guess what?  I have a date tonight.” I can’t help but smile back. Filed under: Men’s Health , Plastic Surgery Tagged: Anthony Youn M.D. — plastic surgeon

Seimens A Seimens molecular CT scanner The Health Blog caught up at TEDMED with Gregory Sorensen , chief executive of Siemens Healthcare in North America, to talk about the changing health-care field and what it means for diagnostics, an area in which Siemens is a player. “We’re beginning to see resurgence in diagnostics as a way to save costs,” Sorensen, formerly a radiology professor at Harvard Medical School, told the Health Blog. A missed diagnosis is a big cost driver in health care because it wastes time and money on ineffective therapy, he said, pointing to an example of studies in Alzheimer’s showing that upon autopsy, some 15%-20% of patients examined had a different ailment than believed and would have been treated differently when they were alive. Of course, there’s been an outcry about the unnecessary use of medical tests and Sorensen acknowledges there has been overuse in the past. Reductions in Medicare reimbursement rates have curbed overuse, he says, though not everyone agrees on that, as the Health Blog reported last week. The important thing now, Sorensen says, is to make sure people are getting the right diagnostic tests, rather than reduce the absolute number of them. He recalled being a doctor in training in the late 1980s, when his professors taught him that, because of the risks associated with appendicitis, doctors should be conservative whenever a patient reported pain in the lower right quadrant of the abdomen. A good surgeon, therefore, would do exploratory surgery on five patients for every one that actually had appendicitis. Sorensen himself had his appendix — which turned out to be healthy — removed during this era. Now patients get scanned if they report such pain, resulting in many fewer unnecessary surgeries, said Sorensen. Siemens recognizes how important it is to demonstrate effectiveness in today’s health-care business, and that payers want to see results, says Sorensen. As for the shift to reimbursement for value, “that train has left the station.”

They don't call it "The Big C" for nothing. People don't even like to say the word out loud. The good news, we're told, is that there are many things we can do – or not do – in our adult lives to lower our risk of developing different types of cancer. Want to avoid lung cancer? Don't smoke. Want to lower your risk of skin cancer? Stay out of the sun, or utilize a proper sunscreen. But a new study published Monday in Cancer suggests that at least one decision our parents make FOR us may have an impact on our predisposition to certain types of cancer. Researchers at the University of Washington School of Medicine looked at the association between circumcision and the prevalence of prostate cancer. They concluded that circumcision before first sexual intercourse is associated with a 15% reduction in the relative risk of developing prostate cancer. It's important to note, right off the bat, that this study is not purporting to establish a cause and effect relationship. As is often the case, there are many additional factors at play. First, a bit of background. It has long been established that men who are uncircumcised are more prone to contracting sexually transmitted infections. As the study's authors point out, "The mechanism(s) by which circumcision reduced acquisition of an STI [sexually transmitted infection] is thought to be related to the microenvironment of the thin, lightly keratinized mucosal lining of the inner foreskin." This tissue is subject to small tears that allow potential access of pathogens into the bloodstream. Furthermore, "The moist environment under the preputial skin may help pathogens survive for extended periods prior to direct infection." Circumcision, of course, removes this protective environment. Why is this important? Infections are reported to cause almost 20% of cancers worldwide, either directly by infection, or indirectly via inflammation.  Several STIs - such as gonorrhea, Chlamydia, HPV & HIV – have been found in the prostate. Participants in the study were asked about their family’s medical history, which may increase a man’s risk of developing prostate cancer, and their PSA screening history, which can lead to overdiagnosis of the condition . Men were also asked to self-report their circumcision status, number of sexual partners, and their history of STIs. Circumcision was reported in 68.8% of the cases and 71.5% of the controls.  Caucasian men more commonly reported circumcision (69%) than African American men (43%). For 91% who reported circumcision, the procedure was performed shortly after birth. A few potential caveats to note include the reliance on self-reporting when it comes to a man's history of STIs, as well as his sexual partners. A cursory review of the data suggests, for example, that the number of male sexual partners is greatly underreported. Male-to-male sexual activity has been shown to lead to an increased rate in STIs, including HIV. This gives pause to make one wonder what other facts were underreported, though the numbers of circumcised vs. not circumcised do fall in line with national survey results. The bottom line from the American Cancer Society: While this is an interesting finding, it's not likely to spur any change in recommendations or medical practice. Filed under: Cancer , Health , HIV/AIDS , HPV , Men’s Health , Sex Tagged: Ben Tinker – CNN Medical News Senior Producer