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MEN'S HEALTH articles from the annual symposia

 

Diagnosing and managing androgen deficiency in men

24 Apr 2017Paid-up subscribers

Androgens play a crucial role in bone, muscle and fat metabolism, erythropoiesis and cognitive health. In men aged 40-79 years the incidence of biochemical deficiency and symptomatic hypogonadism is 2.1-5.7%. Decreased libido or reduced frequency and quality of erections, fatigue, irritability, infertility or a diminished feeling of wellbeing may be presenting complaints. However, a significant proportion of men with androgen deficiency will be identified when they present for unrelated concerns.

Diagnosing testicular lumps in primary care

24 Apr 2017Paid-up subscribers

Although the incidence of testicular cancer has increased over the past few decades, testicular tumours are still rare and many GPs will only see one or two new diagnoses in their career. When examining scrotal swellings, the key question is whether the lump is intra- or extra-testicular, as palpable intra-testicular lesions are highly likely (around 90%) to be malignant, whereas those lying outside the testis are usually benign.

Managing lower urinary tract symptoms in men

25 Apr 2016Paid-up subscribers

Up to 90% of men aged 50 to 80 may suffer from troublesome LUTS. A thorough urological history is essential to inform management. It is important to determine whether men have storage or voiding LUTS or both. Based on history, examination and investigation findings an individualised management plan should be formulated.

The role of PSA in detection and management of prostate cancer

25 Apr 2016Paid-up subscribers

The prostate specific antigen (PSA) test clearly provides the opportunity for clinically relevant prostate cancer to be detected at a stage when treatment options are greater and outcomes may be improved. In addition, a raised PSA may often indicate benign prostatic enlargement, and this may provide an opportunity for treatment of this condition before complications develop. However, in some patients the PSA test may lead to investigations which can identify clinically insignificant cancers which would not have become evident in a man’s lifetime.

Careful assessment key in managing prostatitis

23 Apr 2015

Prostatitis is a common condition estimated to affect up to 30% of men in their lifetime, it is most prevalent in men aged between 35 and 50. Prostatitis is subclassified into: acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain and asymptomatic inflammatory prostatitis. Clinical assessment includes a thorough history and examination. A digital rectal examination should be performed after a midstream urine sample has been collected for urine dipstick, microscopy and culture. The prostate should be checked for nodules.

New developments in metastatic prostate cancer therapy

23 Apr 2015Paid-up subscribers

Advanced prostate cancer remains an incurable and lethal disease. Innovation continues to provide new hope for patients with advanced disease, with improved survival while maintaining quality of life. As patients live longer with increasing treatment options, education of all healthcare professionals involved in their care is crucial in ensuring holistic care for this complex disease.

GPs have key role in managing men with testicular cancer

22 Apr 2014Paid-up subscribers

Testicular cancer accounts for 1% of all malignancies in males. However, it is the most frequently occurring solid tumour in men between the ages of 15 and 34 years. Testicular tumours have excellent cure rates, even in those with metastases, as they are extremely sensitive to chemotherapy and radiotherapy. Early diagnosis is, however, very important as treatment is more successful and less intensive, and long-term health consequences can be minimised. [With external links to current evidence and summaries]

Optimising the management of early prostate cancer

22 Apr 2014Paid-up subscribers

A suspicion of a diagnosis of prostate cancer is usually based on either induration or nodularity of the prostate on digital rectal examination or, more commonly, a rise in serum prostate specific antigen (PSA) level. The usual cut-off point for PSA is taken as 4 ng/ml, but in men below 65 a value of more than 2.5 ng/ml should raise suspicion. The Gleason grading of any cancer identified is an important part of the decision-making process concerning the need for active treatment, as opposed to surveillance alone. Gleason pattern 6 cancers are regarded as low risk, Gleason 7 intermediate risk and 8-10 high risk. [With external links to the current evidence base]

Managing epididymo-orchitis in general practice

25 Apr 2013

Epididymitis and orchitis normally co-exist with isolated epididymitis being more common than an isolated orchitis. Sexually transmitted infection is the most common cause in younger men and urinary tract pathogens are the more common culprits in older men. The most common pathogens in the under 35s are N. gonorrhoeae and C. trachomatis and E. coli is the most common cause of acute epididymitis in the over 35s. Acute testicular torsion is the most important differential diagnosis of acute testicular pain especially in younger men. If there is any suspicion of testicular torsion, the patient should be referred to secondary care immediately as surgery is required within four to six hours.

Advances in the treatment of metastatic prostate cancer

25 Apr 2013Paid-up subscribers

Prostate cancer is the most common cancer in men in the UK. It accounts for nearly a quarter of all male cancer diagnoses and is the second most common cause of male cancer death. Most patients present with localised disease, but there are still many who present with metastatic disease. Medical castration using LHRH analogues has become the gold standard in managing both locally advanced prostate cancer, in combination with radiotherapy, and metastatic disease. Eventually most men with advanced prostate cancer become resistant to androgen deprivation therapy. This is called castrate refractory prostate cancer, and is associated with a poor prognosis. There is now hope for patients who progress after chemotherapy with the emergence of several new agents that have been shown to benefit patients. [With external links to the current evidence base]

Is there a link between BPH and prostate cancer?

25 Apr 2012Paid-up subscribers

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.  [With external links to current evidence and summaries]

When should patients with varicocoele be referred?

24 Apr 2012Paid-up subscribers

Varicocoele is present in 15% of men. Patients suspected of having underlying malignant pathology or with significant discomfort from a large varicocoele should be referred for specialist review. The data regarding the relationship between the condition and infertility is inconclusive. NICE does not recommend surgical treatment of varicocoele for infertility. Patients or couples with infertility should be referred to a urologist with a specialist interest in fertility and an expert in assisted reproduction techniques, ideally to be seen in a joint clinic.

Improving lower urinary tract symptoms in BPH

19 Apr 2011Paid-up subscribers

Benign prostatic hyperplasia (BPH) is one of the most common diseases to affect older men.Histological (microscopic) BPH, which is characterised by both stromal and glandular hyperplasia, is present in more than 60% of men beyond their sixties. More than 40% of men in this age group have lower urinary tract symptoms (LUTS) and about half this group have impaired quality of life. The prevalence increases with age, and the overall number of patients affected is rising worldwide as populations age. At current intervention rates, about one-fifth of patients with symptomatic disease who present to a doctor will eventually be treated surgically, although this may be falling. The remainder will often be managed initially by watchful waiting. However, the majority of these individuals suffer gradual progression of symptoms and the bother associated with them, and increasingly require treatment either with medication or surgery. [With external links to the evidence base]

Managing patients with acute urinary retention

18 Apr 2011Paid-up subscribers

Acute urinary retention (AUR) is a common urological emergency. AUR is more than ten times more common in men than women. AUR in men tends to occur in the elderly and the risk of AUR is higher in men > 70 years. Those in this age group have a 10% risk of developing AUR over a five-year period. The incidence of AUR is low in the general male population of 45 years or older.  However, in almost 50% of AUR patients with benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS), AUR was their first symptom. GPs can play a major role in identifying patients who need assessment for BPH/LUTS and starting early treatment with pharmacotherapy. Health education should address the importance of compliance with medication and patients should be followed up to reduce the risk of AUR and surgical intervention. Urological intervention may only be required in cases where specialised assessment or treatment is needed and in patients where catheter insertion has failed during an episode of AUR.

Nice Evidence

Acute urinary retention

https://www.evidence.nhs.uk/search?q=Urinary+retention

PubMed

Acute urinary retention

http://www.ncbi.nlm.nih.gov/pubmed/?term=acute+urinary+retention

Advances in the diagnosis and treatment of prostate cancer

15 Feb 2010Paid-up subscribers

GPs are increasingly becoming involved in the care of patients with prostate cancer. Prostate cancer is currently diagnosed in more than 34,000 men every year. It claims more than 10,000 lives per annum in the UK, and many more than that internationally. 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 [ time of writing 2010] 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.  [With external links to current evidence and summaries]

Diagnosing urological disorders in ageing men

14 Feb 2010Registered users

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. [ With external links to the evidence base]

Early detection the key in prostate cancer

01 Feb 2009Paid-up subscribers

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. [With external links to the evidence base]

Suspicious testicular lumps warrant urgent referral

01 Feb 2009Paid-up subscribers

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. [With external links to the evidence]

Early detection of erectile dysfunction may prevent CVD

23 Jan 2008Paid-up subscribers

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. [ With external links to the evidence base]

Improving disease outcomes in men

23 Jan 2008Paid-up subscribers

Men are at an increased risk of premature mortality across all major disease areas. There are three possible explanations:• Men are biologically more vulnerable than women; • Men's lifestyles (such as higher rates of smoking and alcohol intake) create more life-limiting disease • Men are more reluctant or unable to seek early medical attention. It appears that the health of men, in particular the ways in which men may be uniquely at risk, is still failing to receive adequate attention. [With external links to the evidence base]

When should patients with BPH be referred?

23 Jan 2008Paid-up subscribers

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.[With external links to the evidence base]

Acute scrotal pain needs prompt investigation

01 Jan 2007Paid-up subscribers

Scrotal pain has a variety of causes, which can lead to considerable morbidity and mortality if left undiagnosed. It is important to establish the aetiology to ensure appropriate investigation and management. Causes of acute scrotal pain have been identified by various retrospective reviews in children: in a review of 238 cases, 16 per cent were caused by testicular torsion, 46 per cent by torsion of the testicular appendage and 35 per cent by epididymitis. Given the proportion of patients who have testicular torsion, early assessment of scrotal pain is critical. [With links to the evidence base]

Semen analysis is the cornerstone of investigation for male infertility

01 Jan 2007Paid-up subscribers

Around one in four couples will see their gp about infertility problems. Large epidemiological studies show that failure or difficulty in conceiving a child is a surprisingly common, worldwide problem with between one in six and one in seven couples classed as sub-fertile. Sperm dysfunction is the most common cause of infertility and affects one in fifteen men. Studies using semen assessment as the criteria for sub-fertility show that up to one in five 18-year-olds are classed as sub-fertile. Recent reports suggest that the incidence of male infertility is increasing. [With links to the evidence base]

PCA3 improves diagnosis of prostate cancer

01 Jan 2007Paid-up subscribers

A single prostate specific antigen (PSA) measurement is of limited use in differentiating between prostate cancer and BPH, unless it is significantly elevated. When the most frequently used PSA cut-off point of 4.0 ng/ml is employed, a significant number of patients with BPH are identified as false positives for prostate cancer. Men with a PSA of between 4.0 and 10.0 ng/ml have around a 20 per cent chance of having prostate cancer; in those with a PSA of >10.0 ng/ml, the chance of a positive biopsy is 62 per cent. However, the recent Prostate Cancer Prevention Trial (PCPT) demonstrated that 17 per cent of men who were identified with prostate cancer in fact had a PSA value below 4.0 ng/ml, and some patients had a value below 2.5 ng/ml. Annual measurement of PSA may improve accurate diagnosis, but is also controversial. [With external links to the evidence base]