A total of 104 global studies were reviewed, examining nearly 10 million (9,855,000) men and 191,000 cases of prostate cancer. The analysis concluded that being overweight or obese significantly increases the risk of advanced prostate cancer. The link between obesity and advanced prostate cancer is important for primary care. In order to maximise the benefit from PSA testing of asymptomatic men, we should be trying to target higher-risk men and should now think of adding obesity to that list. [With external links to the evidence base]

Pollution caused by fine particulate matter (PM_2.5) is around ten times higher in homes where people smoke indoors compared with non-smoking homes, a study from Scotland has found. Furthermore, home air pollution from smoking appears to dwarf that from outdoor sources. Approximately 20% of those living in smoking homes in Scotland will inhale a lifetime mass of PM_2.5 greater than the median value predicted for a non-smoker living in a heavily polluted urban setting.

Integrated collaborative care substantially improves outcomes for cancer patients with major depression, a UK study has found. GPs have an important role in recognising depression in cancer patients and should bear in mind the high prevalence of depression when carrying out QOF cancer reviews. This study suggests that treatment is unlikely to be effective unless it incorporates some form of enhanced care. GPs may not have access to collaborative care but can provide case management and liaise with local oncology teams.

It has been estimated that around 20% of patients attending their GP are at risk from their drinking or have an alcohol use disorder. Without using specific screening tools GPs may typically detect about 40% of cases they see, but miss the majority. The study authors suggest a single or two question approach to initial screening, followed by either the CAGE or AUDIT test for those who are positive, and onward referral for those who test positive on the more in-depth questionnaire.

This study, from Finland, compared the impact of different lower urinary tract symptoms (LUTS). A total of 3,727 individuals took part, just over half were women. On an individual level, urgency urinary incontinence was the most likely symptom to be rated as bothersome by both men and women, with 30.7% reporting at least moderate bother. It is not the presence of symptoms but the bother they cause the patient that is vital to understand when assessing and managing LUTS. Storage symptoms, particularly urgency and urgency urinary incontinence, are the most likely to cause significant impairment of quality of life. [With external links to the current evidence base]

A recent large meta-analysis has confirmed that women with diabetes have more than a 40% higher risk of incident coronary heart disease (CHD) than men. For GPs this is a timely reminder to consider CHD as a high risk in women with diabetes, and to treat risk factors vigorously. This is especially important because routine screening in the healthy population accustoms us to women being generally at lower risk than men using the current CHD risk tools.

The cardiovascular risks of androgen deprivation therapy (ADT) mean that a definite decision should be made regarding risk versus benefit for all men receiving this treatment. For men with high-risk prostate cancer, however, the oncological benefits of ADT are likely to outweigh the cardiovascular risks. Men receiving ADT should be 'medically optimised' in terms of cardiovascular risk and advice from their GP on exercise and diet is essential. [With external links to the current evidence base]

Teenage girls most at risk of cervical cancer are least likely to be offered HPV vaccination and, those who are, less likely to complete the course, a cross-sectional study of sexual health service users has found. [With external links to current evidence and summaries]

Smokers with a history of anxiety, mood or alcohol use disorders are significantly more likely to be in remission three years later if they quit smoking, an American study has found. Smoking cessation may increase the likelihood of remission, but equally, those who recover may find it easier to quit smoking.

Item 9 of the PHQ-9 can be used to identify patients with suicidal thoughts who are at increased risk of suicide. However, this is just one component of the comprehensive and ongoing risk assessment that should be made for all patients with major depression.

The search continues for treatments for lower urinary tract symptoms (LUTS) to match the long-term effectiveness of surgical intervention but without the peri- and post-operative complications associated with these procedures. The first multicentre, blinded, randomised controlled study of the prostatic urethral lift has shown promising results.  [With external links to the current evidence base]

A prospective cohort study from the UK has found no evidence that varenicline or bupropion raise the risk of depression, self harm or suicide.

As with the original Prostate Cancer Prevention Trial, the use of a 5-ARI, in this case finasteride, was seen to reduce the incidence of prostate cancer by about a third. Although high-grade cancer was more common in the 5-ARI group, after 18 years of follow-up there was no significant difference in rates of prostate cancer specific survival or overall survival between the two groups. Prescription of finasteride or dutasteride as a chemopreventive agent against prostate cancer cannot be justified on the available evidence. [With external links to current evidence and summaries]

For many men, three lifetime PSA tests (mid to late 40s, early 50s and at age 60 years) would be sufficient screening to identify the small number of men developing clinically significant prostate cancer, allowing resources to be concentrated on those at higher risk, a study in the BMJ concludes. The European Association of Urology recommends that all men aged 40-45 years should be offered a baseline PSA to ‘initiate a risk-adapted follow-up approach with the purpose of reducing prostate cancer mortality and the incidence of advanced and metastatic cancer’.

A major trial to determine whether intensive lifestyle intervention would reduce cardiovascular (CV) morbidity and mortality in type 2 diabetes patients has been stopped early because of failure to show benefit in the intervention group. Nevertheless, clinicians may confidently advise patients that improvements in diet and activity will reduce weight, the need for medications and the incidence of sleep apnoea and will improve wellbeing.

A study from a UK teaching hospital looked at 2,778 patients, 1,867 men, with haematuria, seen between 1999 and 2007. The study authors conclude that cytology testing is costly, adds little value to investigation of haematuria and should be omitted from guidelines for the initial assessment of haematuria.

Patients of empathetic doctors are more satisfied, less anxious, better able to understand and cope with their illness, and more likely to have good outcomes, a systematic review of primary care studies has found. Empathy may improve outcomes in several ways: there may be a direct therapeutic benefit from feeling understood and valued; patients may be more likely to adhere to their treatment and attend follow-up appointments; or the placebo effect of the treatment may be enhanced.

A recent study has potentially identified another risk factor for coronary disease, that of male pattern baldness (androgenetic alopecia).The authors conclude that vertex baldness is associated with an increased risk of coronary heart disease and the strength of this association is dependent on the severity of baldness. This association appears to hold true for younger patients. It should prompt careful evaluation of other cardiovascular risk factors but to what extent it should modify established cardiovascular risk scores is unclear until further evidence is available. 

Screening for depression in patients with coronary heart disease or diabetes does significantly increase the number of patients with recognised depression, but the absolute number is so small that it calls into question the value of screening, a UK retrospective cohort study has found.

Reports of acute HCV infection in HIV-positive men who have sex with men (MSM) have emerged where sexual exposure was the only risk factor. In a systematic review, HIV-positive MSM had approximately four times the risk of acquiring acute HCV infection compared with HIV-negative MSM. The data suggest it would be reasonable to consider routine screening for HCV in HIV-positive MSM.

Addition of CBT to antidepressant drug therapy more than trebles the odds of response for those with treatment-resistant depression, a primary care study has found. The authors suggest that CBT is reserved as an add-on therapy for those who have not responded to drug treatment after 6-8 weeks.