Men's health

Men have a tendency to ignore their health until significant problems develop.  There are some problems which are best caught early so we would encourage our male patients to read on.

Cardiovascular Disease

Particularly if you are a smoker or have a family or past history of heart disease or stroke we would like you to be aware of our smoke-stop, hypertension and cardiovascular services.  See also links to other sites

Testicular Cancer

All men should know about testicular cancer although we see it very rarely.  It does occur in young men and is best discovered early so we encourage self-examination.  See Understanding cancer of the testes

Testicular torsion

Testes are suspended in the scrotum by their blood vessels and the spermatic cord.  Rarely one can rotate cutting off its blood supply - this is called torsion of the testis and causes severe pain of sudden onset. If the testis is to survive it is important, if you develop these symptoms, to go to one of the local Hospital Accident and Emergency departments straight away and not wait for a doctor's appointment.

Benign Prostatic Hypertrophy

BPH is much more common than prostate cancer and will eventually affect most men to some degree - see Talking BPH

Prostate Cancer

Many men will perceive that there is an epidemic of prostate cancer because more and more men are being diagnosed with it largely because we have the PSA blood test.  Research by the primary care trust has shown that the mortality from prostate cancer is essentially unchanged over the last 10 years and there is considerable evidence that many of the men diagnosed have slow-growing tumours that pose no immediate risk to their health.

Facts about Prostate Cancer

• Prostate cancer is the commonest cancer in men in the UK, affecting about 1 in 14 men over a lifetime
• It is rare under age 50 years
• Most prostate cancers are slow growing and many men are unaware that they have this cancer – many die ‘with’ it rather than ‘of’ it
• A small proportion of prostate cancers grow more quickly and can spread to other parts of the body
• Despite more prostate cancer being diagnosed in the most affluent areas of the South West Region (higher incidence), there is no difference in the rate of mortality due to prostate cancer across the Region.  This suggests that picking up more prostate cancer, possibly earlier in its natural history, is not affecting the death rate due to the condition

To screen, or not to screen?

• A safe, effective screening programme should, overall, result in more benefit than harm
• There are internationally recognised criteria for screening programmes
• A UK National Screening Committee (NSC) reviews all the evidence regularly about current, and potential programmes.  It does not recommend prostate cancer screening
• This is because a prostate cancer screening programme would not meet the necessary criteria :
  • It is not clear that picking up prostate cancer early leads to better outcomes
  • There isn’t a good screening test - the only available test (Prostate Specific Antigen; PSA) has a very high rate of false positives (about 74% - see over)
  • There can also be false negatives where men with prostate cancer have a negative PSA test result
  • Faced with a positive PSA result, the usual next step is a transrectal biopsy
  • Once prostate cancer is diagnosed, there is no clear consensus about the best treatment.  There is conflicting evidence about the benefits of early radical treatment
  • Treatment can result in impotence and incontinence
  • At population level, the chance of harm overall is considered greater than the chance of benefit

What the UK National Screening Committee recommends

• Men should not be offered screening using the PSA test (e.g. in a ‘well man’ clinic)
• Recognising that men often come forward to ask about having the test, the NSC recommends that balanced information in the form of a leaflet (see later) should be provided to them in primary care about the pros and cons of the PSA test
• Men should then have the opportunity to discuss this with their GP or practice nurse before reaching a personal decision to go ahead with the test, fully aware of all the facts

Dorset Local Referral Guidelines

This document is based on the guidance of the UK National Screening Committee and the National Institute for Health and Clinical Excellence.  It has been developed in consultation with GP colleagues and our Consultant Urologist colleagues at Royal Bournemouth Hospital.  Recently it has been approved for dissemination across Dorset (including Bournemouth and Poole) by the Dorset Cancer Network Urology Site-Specific Group, the Dorset Public Health Network and by Dorset and Somerset Strategic Health Authority.

Men with no prostatic symptoms (see below) asking about PSA testing in primary care settings should be offered a copy of the patient information leaflet  - see: http://www.cancerscreening.nhs.uk/prostate/informationpack.html followed by a discussion with a GP.  If time does not permit, or if the man decides to think it over, he should be asked to come back for a second appointment should he decide he wants to proceed with a PSA test.

The GP should enquire about any symptoms which may be indicative of prostatic disease (frequency, urgency, poor stream etc) and any positive family history of prostate cancer.  In either case a PSA test is appropriate to evaluate symptomatic men or those with a family history

For men without symptoms, or positive family history the GP or practice nurse should be prepared to discuss:

• False positivity rates of PSA and the possibility of false negatives

• Complications of prostate biopsy (pain, bleeding, infection)

• No clear consensus about optimal management of prostate cancer

• Common complications of radical surgery or radiotherapy (impotence, incontinence, proctitis)

For all men, when a decision is made to proceed with a PSA test a digital rectal examination should be done

The PSA test should NOT be undertaken:

• within ONE WEEK of ejaculation

• if a urinary tract infection (UTI) is suspected or

• within 3 weeks of a the completion of successful treatment of a UTI

 Patients with DRE findings suspicious of prostate cancer, and/or elevated age specific PSA levels should be referred to the urology team according to the ‘fast-track’ urgent cancer referral rules

Further Information

• Prostate cancer -- understanding NICE guidance
• The Cancer Research website has a host of detail

Page last updated June, 2009