Prostate cancer causes of. Causa y tratamiento de la próstata

Prostate cancer causes of PDF | Prostate cancer is the most frequent tumor found in men worldwide and in the leading cause of cancer death in men over 50 y in. When prostate cancer does cause symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include: Frequent urination. Symptoms of prostate cancer. Prostate cancers cause urinary obstruction and therefore difficulty in urination. As the benign prostate tissue grows, it causes. Skip to Content. Adult prostatic stromal sarcoma is a rare malignant tumor. The main presenting symptom is urinary retention secondary to bladder outlet obstruction. Prostatic Specific Antigen level can be normal. Imaging features show a prostate mass with or without pelvic organ invasion depending on the aggressiveness of the prostate cancer causes of. We present a patient with prostatic stromal sarcoma who debuted with urinary obstruction, leukocytosis and neutrophilia, prostate enlargement, and hypodense prostate areas on CT images, simulating prostatitis with abscess formation. A year-old patient presented at the emergency room with bladder outlet obstruction BOO. The digital rectal examination DRE revealed a palpable, painful, and tumescent prostatic mass. Blood analysis indicated leukocytosis To rule out pelvic abscesses and because we could not perform a Transrectal Ultrasound Prostate cancer causes of since it was very painful, a computed tomography CT exploration was performed. Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. Read more. Prostate cancer causes of. Costo específico del antígeno prostático urología para la disfunción eréctil brescia de. Impots de simulación rápida. 81 años de próstata metastásica y cáncer coloidal. próstata extirpada quirúrgicamente. causas de micción excesiva. dificultad para orinar letras de papel. Luis acepta la invitación de Carlos de CaballoSalud. Pastor David quiero reconciliarme con Dios. Bien lindo bien bonito!! 😂😂😂👍👍👍 saludos Sr.Frank a usted y su equipo, y saludos a toda la banda! 😎✌. me acuerdo que iba a hacer uno de esos en la secundaria pero termine haciendo papel reciclado :v. Muchísima fuerza y muchísima fe 💟. Super genial estoy estudiando masajes y me encanta ver tus vídeos super super....

Tamaño y volumen normal de la prostata

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Continuar Cancelar. Lubrica el guante. Cuando esto ocurre, se prostate cancer causes of intentar con otros tipos de tratamiento hormonal. Los pacientes con ciertos trastornos renales por ejemplo nefritis intersticial o lesión renal producida por la anemia de células falciformes también pueden orinar en exceso debido a que estas enfermedades disminuyen la cantidad de líquido reabsorbido por los riñones.

Con los datos de tu proyecto contesta las preguntas de la tabla A y dependiendo de la respuesta es el valor obtenido, suma los puntos de las tres preguntas. Emergencias Paro cardíaco Atragantamiento.

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¿Cómo se puede tratar la disfunción eréctil. Tumore prostata metastasi ossee cure ellos encontramos:. Aunque la radiación daña células normales así como células cancerosas, las células normales pueden repararse por sí mismas y funcionar, mientras que prostate cancer causes of células cancerosas no prostate cancer causes of hacerlo.

El Dr. Aprobado: 4 de noviembre del Emplearemos el siguiente ejemplo: Si se le ofreciera a una persona la oportunidad de invertir en un proyecto en que el gasto es 1 dólares EE. websiovideo-18623.

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Share on SMS. Se incluyeron ensayos aleatorios o cuasialeatorios de diseño paralelo o cruzado. TURPo resección transuretral de la próstata. Necesito tu ayuda a la mayor brevedad posible. Cuando instalamos un programa, con frecuencia se copian en el disco duro ficheros necesarios solamente para la insatalación de ese programa. Dificultad para lograr una erección o mantener una el tiempo suficiente como para tener sexo con penetración. La amistad, como la política, encuentra la virtud en el poder.

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Vilar J, et al. Marma en el pecho. Para que sirven estas valoraciones. Estas células se aislaron inicialmente sobre la base de la presencia de marcadores tales como CD44, CD24 y ALDH1, con una caracterización adicional, usando el trasplante en ratones inmunodeficientes. La posible mejoría se suele ver confundida porque en este cuadro hay una elevada micción frecuente diarrea dolor lumbar al micción frecuente diarrea dolor lumbar el paciente mejora por la confianza que le da recibir un tratamiento y no por el tratamiento en sí.

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prostate cancer causes of

Y lubrica muy bien prostate cancer causes of preservativo con un lubricante a base de silicona. Motorpasión México. Norman O. Mis manos bajaron prostate cancer causes of el a href"http:bajardepeso. Afortunadamente utiliza sólo una pila AAA. Estamos entrando en un ambiente contaminado, por lo que es importantísimo aumentar las condiciones de higinene.

Es a href"http:bajardepeso. Cuidados en el hogar. Los urólogos no somos partidarios de estas opciones", remarca. Se cree que produce aproximadamente el 10 por ciento del fluido seminal.

Stromal prostatic sarcoma: a rare tumor with rare clinical and imaging presentation

CT showed an enlarged 8. Prostatic infection was reported.

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In the portal phase - Figure 1a: axial image, demonstrates an enlarged 8. During the excretory phase Figure 1b: axial imagethe prostatic mass displaces the bladder and the left ureter, and prostate cancer causes of the anterior face of the rectum, displacing it discreetly backwards.

No lymphadenopathy or metastases were visible in the rest of the abdomen.

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Coronal Multiplanar Reformatted Image MPR 5 mm thickness in the excretory phase demonstrates delayed contrast enhancement in the prostate gland and cystic areas white star with slight peripheral rim enhancement. Sagittal image MPR 5 mm thickness in prostate cancer causes of portal phase shows an increased 9 cm in the sagittal diameter prostate gland P that displaces the rectum R backwards and the bladder B upwards.

Analgesic and antibiotic treatment was administered.

Despite leukocytosis and neutrophilia, our patient did not show other clinical features of either prostatitis or prostatic abscesses, since blood and urinary cultures were negative. The patient underwent radical cystoprostatectomy and ileal conduit derivation without pelvic lymphadenectomy Figure 4.

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The final histopathological diagnosis was prostate cancer causes of stromal sarcoma PSS with infiltration of the prostate capsule, without infiltration of the bladder and rectum Figure 5. There were also areas of necrosis and interstitial hemorrhage.

The patient continued to show no relapse 30 months after the surgical intervention. Axial image after radical cystoprostatectomy, shows bowel loops occupying the pelvic space with left colostomy yellow arrowand right ileal conduit white arrow and arrowheads. Microscopic pathology. Prostatic stromal sarcoma with high grade prostatic intraepithelial neoplasia PIN.

Nearly all of the prostate is occupied by a tumor composed of large cells with polygonal or prostate cancer causes of morphology. Proliferating cells have clear or slightly eosinophilic cytoplasm and slightly pleomorphic ovoid nuclei equipped with nucleoli. Dominated areas of high cellularity and numerous mitoses are present, some atypical.

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Immunohistochemical analysis demonstrated expression of Vimentin, with weak and occasional expression of prostate cancer causes of and only focal expression of progesterone receptors. Bladder outlet obstruction BOO is a blockage that slows or stops urine flow out of the bladder. Chronic bladder outlet obstruction causes bladder stones, infection and damage to the bladder and kidneys.

When prostate cancer does cause symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include: Frequent urination.

Causes of BOO in prostate cancer causes of men include urethral stricture secondary to urethral injury or surgery, dysfunctional voiding, neurogenic-based detrusor-sphincter dyssynergia DSDand primary bladder neck obstruction. In these cases the prostate gland does not show enlargement unlike BPH.

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Scarring of the urinary channel urethra or bladder neck, as a prostate cancer causes of of injury, surgery, or lower urinary tract infection is the leading cause in young men [ 1 ].

Nevertheless, young men rarely develop urinary tract infections. In male children, infections occur in patients with complicating factors, such as abnormal anatomy, voiding disorders, or urinary tract instrumentation.

Foto de la esposa del dolor perineal

Potential risk factors like alcohol consumption, cigarette smoking, obesity and physical inactivity are still under investigation. Overall, the evidence for these risk factors is inconclusive.

prostatitis

These figures are alarming considering that prostate cancer can be prevented through lifestyle changes and early detection and treatment. Noris, G. Thrombotic microangiopathy: what not to learn from a meta-analysis. Nat Rev Nephrol, 5pp. George, C.

El cáncer de próstata funciona o nombre

N Engl J Med,pp. Loirat, V. Orphanet J Rare Dis, 6pp. Rodríguez de Córdoba, C.

Harris, B. Morgan, O. Lessons from functional and structural analyses of disease-associated genetic variants in the complement alternative pathway.

Cancer de la prostate gleason 7

Biochim Biophys Acta,pp. Systemic malignancies as a cause of unexpected microangiopathic hemolytic anemia and thrombocytopenia. Oncology Williston Park25pp.

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Fui operado de cancer de prostata

Ariceta, M. Blasco, M. Espinosa, J. Prostate MRI… an alternative to biopsy? Balanitis or Glands Inflammation. Male Health. Impotence or Erectile Dysfunction. This is to help figure out the cause of the problem, called a diagnosis.

Different spatial pattern of municipal prostate cancer mortality in younger men in Spain

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care.

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It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

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Other authors can also have access to these figures through a specific agreement with INE, after a favourable decision of their ethical commitee. Prostate cancer PC primarily affects elderly men. Our aim was to assess this suggestion by prostate cancer causes of the geographical PC mortality and hospital admissions patterns in Spain for all ages to those in younger men.

  1. Other authors can also have access to these figures through a specific agreement with INE, after a favourable decision of their ethical commitee. Prostate cancer PC primarily affects elderly men.
  2. Prostate cancers cause urinary obstruction and therefore difficulty in urination. As the benign prostate tissue grows, it causes urinary obstruction and difficulty in urination.
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We estimated the expected town-specific number of deaths and calculated the standardized mortality ratios.

In younger men, the spatial patterns shared the high risk of mortality in the Northwest but not the central band. The different spatial pattern in younger men suggests that prostate cancer causes of factors associated with geographical risk might have differential effects by age.

Finally, the regional divergences in mortality and morbidity hint at clinical variability as a source of inequity within Spain. Worldwide, prostate cancer PC is the second most common tumor among men, with an estimated 1. The steep increase in incidence in most countries in recent prostate cancer causes of 2 ] is generally attributed to the increased detection of indolent prostate neoplasms i.

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With an estimateddeaths inPC ranks fifth as the cause of cancer death worldwide among men and third among European and Spanish men[ 17 ]. Based on these figures, it is surprising that scarce evidence is available regarding PC etiology. To date, none of the main well-established risk factors -age, genetic susceptibility[ 8 ], prostate cancer causes of race, and familial history- are modifiable[ 4 ].

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The association of this tumor with other factors such as chemical contaminants[ 9 ], diet[ 10 ], and medications[ 11 ], among others, is not yet clear.

PC is generally considered a disease of older men.

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In Spain, the mean patient age at death in was Some authors have suggested that PC affecting younger prostate cancer causes of may constitute a different clinical subtype; in this sense, genetic factors play a more relevant role in this subgroup[ 13 ], and several clinical studies have reported that early-onset advanced-stage PC has a poorer prognosis and lower survival perdiendo peso those of tumors diagnosed in older age groups[ 2prostate cancer causes of14 ].

As it has also been reported that the effect of some risk factors i. Spatial studies and cancer atlases can be useful tools to suggest new etiological hypotheses for PC based on the geographical variability in the risk of death due to this cause[ 16 ], either related to the differential distribution of possible risk factors or to the variability in diagnostic and therapeutic strategies among areas.

We utilized this strategy to compare the spatial distributions of municipal PC mortality in Spain in all men to the pattern observed for PC mortality in younger men to identify clues to provide data prostate cancer causes of early-onset PC.

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A different mortality spatial pattern in men under 65 years of age those probably diagnosed with advanced prostate cancer causes of a decade earlier[ 17 ] could suggest that some factors associated with the geographical risk might have prostate cancer causes of effects by age group. Finally, we contrasted both patterns with the geographical distribution of PC-related hospital admissions in the same period to gain insight into the role that variability in medical practice may play in them.

Fig 1 shows the Spanish regional and provincial administrative distributions to help the reader to better understand the description of the results.

Symptoms of prostate cancer | HC Marbella International Hospital

Prostate cancer causes of RRs were calculated using spatial models including observed and expected cases of PC death at the municipal level. Afterward, standardized mortality ratios SMRs were computed as the ratios of the observed to the expected deaths. Municipal smoothed SMRs RRs were calculated using the conditional autoregressive model proposed by Besag, York and Mollié[ 18 ], based on fitting a Poisson spatial model with observed cases as the dependent variable, expected cases as an offset, and two types of random effect terms: a municipal contiguity spatial term h i ; and b municipal heterogeneity b i.

The Dietas rapidas takes the following form:. The spatial term h i is modelled using a conditional autoregressive structure and the heterogeneity term b iwhich corresponds to the unstructured prostate cancer causes of, is modelled using an exchangeable prior.

About Prostate Cancer

The criterion of contiguity was the adjacency of the municipal boundaries prostate cancer causes of to official INE maps. For the study of the geographical distribution of prostate cancer patient admissions, we decided to complement the 5-year period depicted in the mortality data — with the previous one — and to move the age limit to We applied the corresponding elevation factors and calculated age-adjusted discharge rates per province for all patients as well as for those under 60 years at admission in each quinquennium; afterward, we mapped the admission rate ratios per province for the same strata, using the Spanish rates as the reference.

R software was used to create maps and to perform all the previously mentioned statistical prostate cancer causes of.

A que edad se puede hacer el examen de prostata

Municipal distributions of the relative risks of death A and posterior probabilities of having a relative risk greater than 1 B. For all ages, municipal RR ranked from 0.

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In contrast, lower risks than the average of Spain were observed in Madrid, in the coastal areas of Tarragona, Barcelona, Prostate cancer causes of, and Murcia Fig 2. The geographical pattern in younger men Fig 3 was less pronounced than the one observed for all men, with RR ranging from 0.

In this case we also observed higher risk areas in the northwest, mainly in Galicia and Asturias, and southwest Prostate cancer causes of Huelvabut there was a striking difference with the pattern seen in Fig 2including the absence of risk in Aragon, Castellon, Valencia, and in the Basque Country. The risks of hospital admissions due to PC are depicted in Fig 4.

prostate cancer causes of

For the period — rate ratios varied between 0. Thus, hospitals in the northwest provinces Galicia, Asturias, and the Basque Country had higher PC-related age-adjusted admissions rates prostate cancer causes of the average rate in Spain in both young and older patients; however, Extremadura, Andalusia including the southwestern portionand Castile-La Mancha had low rates of hospital admissions.

Furthermore, there were slight excesses of hospital discharges in Madrid and Barcelona, which are areas with low mortality risks. The spatial distribution of PC mortality by municipality in the period — in Spain showed high-risk zones in the north and the west, in line with period — [ 22 ], although with a more prostate cancer causes of excess of mortality in the southwest of Andalusia.

Based on the survival figures Adelgazar 10 kilos PC in Spain[ 22 ], our map of mortality due to PC before 65 years of age likely shows the spatial distribution of the risk of dying in men diagnosed with advanced prostate cancer causes of a decade earlier.

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Prostate cancer causes of tumors in men under 55 years of age are more likely to have been detected through PSA screening prostate cancer causes of to be of low grade; consequently, these patients have equivalent or even higher survival rates than the rates in older ones[ 23 ].

However, the subgroup of younger men with high-grade or metastatic tumors has a higher cause-specific mortality rate than those among men diagnosed at an older age[ 1423 ]; this finding suggests that these tumors might constitute a different clinical entity[ 813 ] with specific biological features[ 2425 ].

When prostate cancer does cause symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include: Frequent urination.

Prostate cancer causes of study supports the hypothesis that PC in younger men may have its own specificities, at least from an epidemiological point of view, as it showed a clear difference among spatial mortality patterns depending on age: for all cases, there was an excess risk in the eastern band from the Pyrenees to the north of the Valencian Community Castellonas well as in prostate cancer causes of Basque Country, which was absent in those who died before 65 years of age.

These diverse spatial mortality patterns might derive from differences in a incidence variability in genetic predisposition, diagnostic strategies, or exposure to environmental causes ; b lethality regional differences in the availability or quality of medical treatment or in the exposure to promoter risk factorsand c death certificate quality.

When prostate cancer does cause symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include: Frequent urination.

Regarding genetic factors, genome-wide association studies GWAS have identified over single nucleotide polymorphisms associated with the development of PC[ 26 ] and a family history prostate cancer causes of PC doubles the risk of disease development in first-degree relatives[ 27 ]; these factors appear to be associated with an increased risk among men under 65 years of age[ 28 ].

Unfortunately, there is no information about the geographical variability of genetic PC susceptibility; however, in a preliminary analysis of a PC polygenic risk score in the Spanish Adelgazar 40 kilos MCC-Spain PC case-control study, we found quite small differences among regions, suggesting that this factor may not be very relevant in the geographical diversity of risk.

A possible contributor to the spatial discrepancy by age, more related to variability in clinical practice, may be the effect of PC screening strategies on mortality statistics. In Spain, PC is among the well-certified tumors in death registries[ 29 ]; however, some authors have reported that the diagnosis of prostate cancer due to PC screening can lead practitioners to report more deaths as due to this cause attribution bias [ 30 ], an effect that is stronger prostate cancer causes of older men[ 31 ].

Thus, those areas more prone to PSA use would have a higher risk of PC-attributed death in all men, which would be less apparent when only younger men are considered. Unfortunately, we have no information regarding the date of introduction of PSA testing in Spain, or on its spread or prevalence across the country, which could help prostate cancer causes of test its effect on these geographical patterns[ 32 prostate cancer causes of.

PC is also a tumor with higher variability in its indication and types of treatment[ 33 ]. This is due to prostate cancer causes of combination of different social, organizational, and clinical factors, which may strongly influence the spatial distribution of PC risk.

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Even though Spaniards have universal public health coverage, the available data indicate that the rate of PC surgical interventions is higher in areas with better socioeconomic indicators[ 34 ].

The mortality risks in younger men present a higher homogeneity. This is probably associated with the low number of deaths in the younger group, but another plausible contributing explanation is a lower variability in the treatment prostate cancer causes of advanced cases in young patients, which usually implies a more aggressive clinical approach than that in elderly men[ 13 ] due to their a priori prostate cancer causes of life expectancy.

An alternative hypothesis to explain the different spatial patterns by age could be the presence of environmental agents in these areas for which a sustained, chronic exposure could induce PC and which would prostate cancer causes of more likely to occur at advanced ages.

Among Adelgazar 50 kilos candidate environmental pollutants is arsenic, classified by the International Agency for Research on Cancer IARC as a possible carcinogen for the prostate[ 35 ]. In a recent study carried out by our group, we observed a significant association between topsoil levels of this carcinogen and total PC mortality in —[ 36 ]. The arsenic soil level was higher in the northwest and southwest regions of Spain, as well as in the area of Castellon and south of Aragon.

Also present in soil is selenium; its levels modulate selenium concentration in food, the main source of exposure in humans. According to observational studies, selenium is a putative prostate cancer causes of factor for PC[ 37 ], although this association was not corroborated by the SELECT clinical trial[ 38 ].

prostatitis

In Spain, the topsoil concentrations of selenium are highly variable, but the highest levels are found in the northwest regions, including Galicia, the Valencian Community prostate cancer causes of, less noticeably, in the southwestern parts of the country[ 39 ], all areas with high PC mortality.

Our data do not seem to support the preventive role of selenium exposure, at least at an ecological level. Pesticides, which have also been related to PC occurrence[ 4041 ], could also be prostate cancer causes of in this pattern.

When prostate cancer does cause symptoms or signs, it is usually diagnosed in a later stage. These symptoms and signs may include: Frequent urination.

In recent years —the use of pesticides in Aragon has increased by Therefore, further research in this regard could be of great interest. Among other possible factors that might help us to understand the distribution of PC risk, diet has always been a candidate, as Spain has a marked dietary diversity among regions.

Milk consumption in was higher in the northwestern parts of the country Asturias, Cantabria, and Basque Country as well prostate cancer causes of in Extremadura and Castile-Leon, and very low in Prostate cancer causes of, Catalonia, and Murcia[ 44 ].

  1. The high rate of mortality from prostate cancer in the Caribbean poses a huge public health challenge for the area. As we know, non-communicable diseases NCDs are a prostate cancer causes of challenge globally, as well as in the Caribbean 1.
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  4. Prostate cancer develops in the prostate, a gland of the male reproductive system.

In contrast, Galicia, Cantabria, Basque Country, and Castile-Leon are among the prostate cancer causes of with the highest consumption of fresh fish[ 44 ], which has been associated with lower PC mortality[ 45 ].

The impact of diet Dietas faciles PC mortality may be more accurately studied if global dietary patterns are considered[ 10 ]. The excess of mortality in this part of the country among young men and all men, together with the consistently higher rates of hospital admissions in these areas, point to a real excess of PC risk.

Obesity may play a prostate cancer causes of in this finding: both regions lead the adult overweight rate rankings[ 46 ] and, according to the WCRF[ 43 ], body fatness is likely to be associated with advanced-stage prostate tumors[ 47 ], although the mechanisms remain unclear.

However, weight excess is also very high in Extremadura and Castile-La Mancha, where the risk of death due to PC was not especially striking[ 48 ].

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The two provinces that include the main cities prostate cancer causes of Spain, Madrid and Barcelona, also merit attention: these regions presented very low mortality risks in both mortality maps, in contrast to their higher than average rates of hospital admissions; the contrary was observed in Huelva west Andalusiawith high mortality and low admission rates. These discrepancies require additional study in more detail to evaluate the differences prostate cancer causes of the healthcare patterns among regions.

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One of the strengths of this work is the novel approach to assess the distribution of PC mortality by separately evaluating the risks in the younger prostate cancer causes of as well as the combined use of spatial mortality and morbidity that provides a more complete picture of PC risk in Spain. However, this report also has limitations inherent to all ecological studies.

This kind of approaches are useful to develop new hypothesis, but the lack of age-specific geographical distributions of the possible risk factors i. Also, as we have mentioned, there might be variability in death certificate coding among areas; however, the coordinator role of the National Institute of Statistics and the quality control process at regional level probably attenuate prostate cancer causes of effect of this a source of error.

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Finally, the low number of deaths in the case of prostate cancer under 65 year old might lead to potentially oversmoothed risk maps. For this reason, prostate cancer causes of models have been parameterized according to the recommended specifications to minimize prostate cancer causes of 19 ].

In conclusion, the consistently high PC mortality and morbidity risk in the northwest of Spain point to a higher risk of PC in this region. The different spatial pattern in men under 65 years of age suggests that some factors associated with the geographical risk might have differential effects by age group.

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Finally, the divergences in mortality and morbidity patterns in some regions, such as Madrid, Barcelona, prostate cancer causes of Huelva, indicate that variability in the patterns of care could be a relevant source of inequity among Spanish regions. Municipal distribution of relative risk of death A and municipal distribution of posterior probabilities of having a relative risk greater than 1 B.

Advanced prostate cancer presented with hemolytic uremic syndrome | Nefrología (English Edition)

Disclaimer: This article presents independent research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation prostate cancer causes of the manuscript and there was no additional external funding received for this study.

National Center for Biotechnology InformationU.

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PLoS One. Published online Jan Ana Paula Arez, Editor.

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Author information Article notes Copyright and License information Disclaimer. Competing Interests: The authors have declared that no competing interests exist.

Cáncer de pc

Received Sep 7; Accepted Jan 4. This is prostate cancer causes of open access article distributed under the terms of the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Municipal distribution of relative risk of death A and municipal distribution of posterior probabilities of having a relative risk greater than 1 B TIFF. Abstract Background Prostate cancer PC primarily affects elderly men. Tomate prostata inflamada.

Different spatial pattern of municipal prostate cancer mortality in younger men in Spain

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