GPs are increasingly becoming involved in the care of patients with prostate cancer. Men dying from advanced disease often suffer intractable bone pain and debilitating lower urinary tract symptoms which have a considerable impact on their quality of life. In the absence of a breakthrough in the treatment of metastatic disease, earlier diagnosis and more effective eradication of clinically significant disease currently seem to afford the best opportunity of stemming the tide.

Urology practice includes large numbers of ageing men presenting with urinary symptoms, haematuria, urogenital cancer and sexual dysfunction. As with women, hormonal changes in men may be associated with significant health-related problems. Often symptoms are misleading in older patients and may be related to different pathology.

Prostate cancer is the most common cancer in men. More than 35,000 new cases are diagnosed annually and almost 10,000 men die each year in the UK from this disease.  Now an increasing majority of patients present with an isolated increase in prostate specific antigen (PSA). In the USA, where PSA testing is widely adopted, the death rate from prostate cancer is falling four times faster than in the UK.

Finding an unusual lump in the scrotum or testicle can be very distressing for patients. Although less than 5% of testicular lumps are cancerous a systematic approach needs to be undertaken in all cases to rule out malignancy. Testicular lumps require careful clinical assessment and may need further investigations such as ultrasound.

Benign prostatic hyperplasia (BPH) is the most common condition to affect older men. Almost half of all men older than 65 years have lower urinary tract symptoms (LUTS), consisting of poor flow and frequency of micturition, which may have a severely negative impact on quality of life. As BPH is generally a disorder of older men, it is frequently associated with comorbid conditions such as erectile dysfunction, hypertension and prostate cancer. These need to be identified and taken into account at the time of diagnosis, as their presence may impact on treatment strategies.The main risk factors for BPH are age, family history and possibly obesity.

Erectile dysfunction (ED) is a common condition defined by the inability to achieve and sustain an erection adequate for sexual intercourse. Population studies estimate a prevalence of between 32% and 52% for all grades of ED.^1,2 ED is more common as age increases, and one study found the prevalence of complete ED to triple, from 5% to 15%, between the ages of 40 and 70.² there is increasing evidence to support a vascular aetiology. ED and cardiovascular disease (CVD) share common risk factors. So modifying risk factors for CVD may lead to an improvement in erectile function. Early identification of ED may also provide a window of opportunity in which clinicians can take preventative measures against the development of CVD. There is increasing evidence to support a vascular aetiology. ED and cardiovascular disease (CVD) share common risk factors. So modifying risk factors for CVD may lead to an improvement in erectile function. Early identification of ED may also provide a window of opportunity in which clinicians can take preventative measures against the development of CVD.