GPs are playing an increasing role in managing both prostate cancer and benign prostatic hyperplasia (BPH). More than 70% of men over 70 years are affected by BPH, and prostate cancer is the most common cancer in men in the UK. GPs play an important part in the initial management of men presenting with lower urinary tract symptoms and in addressing concerns regarding prostate cancer and the significance of the patient’s symptoms. While there is no proven causal link between prostate cancer and BPH, associations have been found. BPH may increase the chance of an incidental prostate cancer being diagnosed through PSA testing and other investigations.

All women with postmenopausal bleeding should be referred urgently. Endometrial cancer is present in approximately 10% of cases. First-line investigation is a transvaginal ultrasound scan. A normal TVUS is reassuring, and if examination is normal further investigation is not required, providing the bleeding has stopped. There is no evidence to indicate whether different patterns of postmenopausal bleeding such as one-off bleeding or more frequent bleeds are more likely to be associated with malignancy.

Kidney cancers account for 2-3% of all adult malignancies in the UK. The incidence has been increasing which may reflect changing risk factors including a rise in obesity. Early diagnosis improves survival with five-year survival rates for renal cancer of 70-94% for localised tumours, in the UK, but this survival rate falls to 40-70% when cancer has spread beyond the kidney.

Vascular dementia (VaD) is common. Pure vascular disease may account for 5–20% of all cases of dementia, while mixed dementia, Alzheimer's disease (AD) with VaD, occurs at least as frequently. It is unusually heterogeneous and frequently overlapping and comorbid with other conditions such as stroke, other cardiovascular and cerebrovascular diseases and their risk factors, as well as AD. There is no specific treatment or cure for VaD, but its proximity to other conditions may make it amenable to interventions at various stages of the disease. Most recent research suggests that VaD and AD occupy ends of the same spectrum and share common risk factors. As VaD is closely related to cardiovascular disease, modifying cardiovascular risk factors may assist in its prevention. Cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, smoking and diabetes are closely associated with cognitive impairment, AD, as well as VaD. Regular screening of high-risk individuals could help to detect dementia early on and enable appropriate preventive intervention. This could involve pharmacological as well as behavioural modulation of risk factors. Medication for hypertension, diabetes and hypercholesterolaemia is recommended, as treatment reduces the risk of developing cognitive impairment and dementia. Behavioural treatments include enhancing and encouraging cognitive and physical activity, social engagement, smoking cessation and healthy diet, including alcohol reduction.  It should not be forgotten that depressive illness or symptoms in old people can affect their cognitive function and worsen existing cognitive impairment.

Back pain is common with up to 9% of the population consulting their GP with this problem each year. As the vast majority of these patients have non-specific back pain, it is often difficult to identify those with inflammatory disease such as ankylosing spondylitis (AS). It is critical to make this distinction as AS, if untreated, may cause significant morbidity with a substantial socio-economic impact both on the individual and society. Early diagnosis is particularly important as newer therapies are able to contain this condition and even induce remission in some cases. AS affects about 0.2-0.5% of the population. It is at least twice as common in men than women and most often manifests in the third to fifth decades. It is estimated that up to 5% of patients with chronic lower back pain in primary care have inflammatory disease. Diagnosis is usually delayed at least partly through lack of awareness of this condition.

Lung cancer is the leading cause of cancer mortality in the UK resulting in more than 33,500 deaths in 2008, 4,000 more than for bowel and breast cancer combined. Five-year survival figures are poor but have recently improved from around 5% to 7.5% in men and 8.5% in women.There is evidence of marked variation in the standard of care in England.  It has recently been shown that if patients are first referred to a thoracic surgical centre, rather than a hospital that does not have thoracic surgeons on site, they are 51% more likely to have a resection. There are similar findings for other active treatments. By reducing this variation there is scope for marked improvement in outcomes, possibly to levels seen in other countries such as Australia, Canada, Sweden and Norway where five-year survival rates are approximately double. Thus there is a need to encourage lung cancer teams to select patients correctly so that the best treatment can be offered. Improving diagnosis, staging and fitness assessment was a major focus in the recently updated NICE guideline on diagnosis and treatment of lung cancer, published in April 2011.