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Concerns about overtreatment of clinically indolent prostate cancer (PrCa) have led to recommendations that men who are diagnosed with low‐risk PrCa be managed by active surveillance (AS) rather than immediate definitive treatment. However the risk of underestimating the aggressiveness of a patient's PrCa can be a significant source of anxiety and a barrier to patient acceptance of AS. The uncertainty is particularly keen for African American (AA) men who are about 1.7 times more likely to be diagnosed with PrCa than European American (EA) men and about 2.4 times more likely to die of this disease. The AA population, as many other populations in the Americas, is genetically heterogeneous with varying degrees of admixture from West Africans (WAs), Europeans, and Native Americans (NAs). Recommendations for PrCa screening and management rarely consider potential differences in risk within the AA population. We compared WA genetic ancestry in AA men undergoing standard prostate biopsy who were diagnosed with no cancer, low‐grade PrCa (Gleason Sum 6), or higher grade PrCa (Gleason Sum 7‐10). We found that WA genetic ancestry was significantly higher in men who were diagnosed with PrCa on biopsy, compared to men who were cancer‐negative, and highest in men who were diagnosed with higher grade PrCa (Gleason Sum 7‐10). Incorporating WA ancestry into the guidelines for making decisions about when to obtain a biopsy and whether to choose AS may allow AA men to personalize their approach to PrCa screening and management. African American men are at higher risk for prostate cancer but public health recommendations rarely consider potential differences in risk within the African American population. We found that in self‐identified African Americans, West African genetic ancestry was significantly higher in men who were diagnosed with PrCa on biopsy, compared to men who were cancer negative, and highest in men who were diagnosed with higher grade PrCa (Gleason Sum 7‐10). Incorporating West African ancestry into prostate cancer clinical guidelines may allow African American men to personalize their approach to screening and management.

Infertility affects 15 percent of couples, and 50 percent of male infertility is potentially correctable. Evaluation of the subfertile man requires a complete medical history, physical examination, and laboratory studies. The main purpose of the male evaluation is to identify and treat correctable causes of subfertility. In addition, many men seek an explanation for their condition, which can be discovered during their evaluation. Furthermore, the male fertility evaluation can uncover significant medical and genetic pathology that could affect the patient's health or that of his offspring. Although pregnancies can be achieved without any evaluation other than a semen analysis, this test alone is insufficient to adequately evaluate the male patient. Treatment of correctable male-factor pathology is cost effective, does not increase the risk of multiple births, and can spare the woman invasive procedures and potential complications associated with assisted reproductive technologies. Appropriate evaluation and treatment of the subfertile man are critical in delivering suitable care to the infertile couple.

Purpose Smoking, inadequate vitamin D and pesticide exposure have been linked to bladder cancer (BCa) in past studies. The objective of this study is to explore associations between BCa rates and these risk factors. Materials and methods BCa incidence and mortality rates among states were compared to smoking; solar ultraviolet (UV) radiation levels and drinking water from a surface water supply (which has greater residual pesticide contamination than groundwater and both are used as sources for drinking water). Lack of health insurance, median family income and urbanization were included to adjust for access to health care and socioeconomic status. Results BCa incidence and mortality correlated directly with smoking and inversely with solar UV radiation for males and females. BCa mortality correlated directly with drinking surface water for both sexes. Lack of health insurance correlated inversely with BCa incidence for females and trended toward significance for males. Multivariable analyses identified solar UV radiation as the best predictor of BCa incidence in males and solar UV radiation and smoking in females. Solar UV radiation, smoking and drinking surface water were the best predictors of BCa mortality in males, while smoking and drinking surface water were the best predictors of mortality in females. Conclusions BCa incidence and mortality for both sexes correlated directly with smoking and inversely with solar UV radiation levels. BCa mortality for both sexes correlated with drinking water from a surface water source. It is hypothesized that BCa mortality risks may increase from drinking water contaminated with low levels of pesticides.