User blog: Rcgp Learning
Prostate cancer is the most common cancer in men, with around 47,000 men diagnosed each year in the UK (1), causing 11,287 deaths in 2014 (2). March is Prostate Cancer Awareness Month, organised by Prostate Cancer UK, and with various prostate cancer events taking place throughout the month, you may find that more patients want to ask about PSA testing and whether they can have the test.
As GP referral is the route with the highest proportion of cases diagnosed at an early stage for prostate cancer, PSA testing in primary care is an important part of the diagnostic chain. The pros and cons of PSA testing in asymptomatic men has been passionately discussed over the years though there is evidence that in some patients it can pick up prostate cancer before symptoms appear and can even identify fast-growing cancers at an early stage.
The Prostate Cancer Risk Management Programme (PCRMP) was reviewed in 2016 to better inform GPs on the best approach. Based on the PCRMP guidelines (1) and suggestions from Prostate Cancer UK (2)(3), here are some key points to take away:
• Any man in the UK aged 50 and over who asks for a PSA test and carefully considers the implications with their GP is should be tested
• Those considered ‘high risk’ for prostate cancer are aged 50 or over, men with a family history of the disease and black men
• The PCRMP guidelines apply when discussing the test with asymptomatic men aged 50 and over who proactively ask about it, not high risk men or men of any age who have symptoms
• GPs should consider offering a digital rectal examination (DRE) to all asymptomatic men who have decided to have a PSA test
• The new recommended prostate biopsy referral value for men aged 50-69 has changed to ≥3.0ng/ml
• The PSA test can miss about 15% of cancers
• All men have the option to be re-tested in the future if their PSA test result is ‘normal’
If you would like to read more about PSA testing and the guidelines around it, here are some resources that may be useful for yourself and your patients:
PCRMP Pack – Further reading on the revised PCRMP guidelines from PHE
PSA Resource Pack – Expert information for healthcare professionals from Prostate Cancer UK
Best Practice Case Studies – A selection of case studies you could apply to your practice from Prostate Cancer UK
The Tool kit – A resource to help men who have been diagnosed with prostate cancer from Prostate Cancer UK
NHS decision aid – An online tool to help men decide whether to have the PSA test from the NHS
In addition to the resources above, you can also find a selection of eLearning materials from the RCGP. Our Prostate Cancer: Early diagnosis in General Practice course is FREE to all healthcare professionals and counts towards your CPD hours. If you’re an RCGP member, you can also access the following courses:
(1) Public Health England. Prostate specific antigen testing: summary guidance for GPs [Internet]. Available from: https://www.gov.uk/government/publications/prostate-specific-antigen-testing-explanation-and-implementation
(2) Cancer Research UK. Prostate cancer mortality statistics. [Internet]. Available from: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/mortality
(3) Prostate Cancer UK. Prostate Cancer UK policy position on the PSA test [Internet]. Available from: http://prostatecanceruk.org/media/2493257/prostate-cancer-uk-policy-position-on-the-psa-test-2016.pdf
While an undeniable force for the good, the internet was not designed with children in mind. Nevertheless an astonishing one third of internet users are under the age of 18, with 12-15 year olds spending over 20 hours a week online. These figures demonstrate the extraordinary influence online media now has over young people, with parents rightly concerned about the impact digital devices have on their children’s wellbeing (1).
According to statistics from the Priory Group, teenagers and young people aged 14-25 are typically the most affected by eating disorders in the UK (2). They are also extremely likely to be active on social media, where they could be exposed to links promoting anorexia as a fashion or as a source of beauty, sharing tips and tactics on how to become and remain anorexic. So what do GPs need to know about pro-eating disorder pages?
Social media is more widespread than ever and with so much information pushed onto mobile devices and desktops, it can be hard to shield teenagers and young people. A survey by EU Kids Online found that 10% of children aged 9-16 had seen eating disorder websites before, with girls more commonly exposed to them than boys (3). Worryingly, these websites are rapidly filtering through to online social networks, such as Facebook, YouTube, Twitter, Instagram and Snapchat.
Pro-anorexia (pro-ana) and Pro-bulimia (pro-mia) websites are part of an online community, promoting eating disorders as a lifestyle. They provide interested users with tips on how to resist eating and suggestions on how to hide the symptoms of doing so from friends and family. They also post ‘thinspiration’: images and quotes to ‘motivate’ their readers. These messages of ‘support’ can easily influence teenagers and young people and the groupthink infusing these communities can provide them with a sense of belonging. They may also encourage sufferers not to listen to concerned adults, such as their parents and GPs.
Although it’s impossible to keep track of the amount of pro-ana and pro-mia information on the internet, there is an increasing number of anti-eating disorder websites out there too. Oksanen, Garcia, & Rasanen (2016) conducted a study into different eating disorder channels on YouTube. Their findings revealed that there is also an anti pro-ana community, who promote recovery and provide information on health organisations. The results of the study showed that anti pro-ana channels were actually more popular than pro-ana channels, generating more views, comments and ‘likes’ (3).
There is a plethora of conflicting messages for teenagers and young people online, and GPs may be relied upon for advice by patients and their parents. Therefore, it is a good idea to be aware of the impact of social media and online communities on your young patients. As an introduction to the topic, why not visit the sites of Anorexia and Bulimia Care or Beat, two of the UK’s eating disorder charities, to learn more about Eating Disorder Awareness week, which runs from 27th February to 5th March 2017.
For more information about the range of different eating disorders and how to manage them in general practice, the RCGP offers an eLearning course on ‘Eating Disorders’ which is FREE to access for all healthcare professionals and also gives you 1 hour towards your CPD.
(1) The Children’s Commissioner. ‘Growing up digital’ A report of the Growing Up Digital Taskforce. 2017 http://www.childrenscommissioner.gov.uk/sites/default/files/publications/Growing%20Up%20Digital%20Taskforce%20Report%20January%202016.pdf
(2) Priory group. ‘Eating disorder statistics’ [Internet] Available from: http://www.priorygroup.com/eating-disorders/statistics
(3) Oksanen A, Garcia D, Räsänen P. Proanorexia Communities on Social Media. Pediatrics. 2016;137(1):e20153372
We’re now on the other side of Christmas and New Year and are likely to be feeling the effects of over-indulging in our favourite food and drinks over the festive period. As fun as it is at the time, we all know that the party season can really take its toll on our health. Therefore, it may not surprise you that 1 in 6 people in Britain took part in Dry January last year.
Dry January is an initiative where participants abstain from alcohol for the whole of January. It’s the flagship campaign from the alcohol charity, Alcohol Concern and was launched around 6 years ago. It has continued to gather momentum each year as people begin to understand the positive effects it can have on their health.
The stats are pretty impressive when you take a look at the benefits of giving up alcohol for just 1 month. Alcohol Concern reports that 62% of participants last year had better sleep and more energy, while 49% said that they had lost weight. In 2013, Mehta and colleagues conducted a study on moderate drinkers and reported that a month without alcohol had an effect on their systolic blood pressure, taking it down from a mean of 135 to 127.
So how can you support patients who want to cut down on their alcohol intake?
It’s likely that they will have already heard of Dry January, and perhaps even attempted it before. However, perhaps they don’t realise that not only is it good for the health, it’s also a way to fundraise and take on a challenge with family, friends and colleagues. For those who need an extra push, Alcohol Concern have also launched a Dry January app. It’s free to download and helps users keep a record of their alcohol-free days, whilst boosting their motivation, with updates on how much money they have saved so far. For further encouragement, they also have an ‘Impact Calculator’ on their website, which calculates the average cost of and calories in a range of different alcoholic drinks. To view the ‘Impact Calculator’, you can visit the Alcohol Concern website here.
For further information on the Mehta (2013) study and some tips on how to approach the subject of alcohol intake with your patients, take a look at our ‘Health benefits of stopping alcohol for one month’ screencast. It’s FREE to all healthcare professionals and also counts towards your CPD hours.
If you want a more detailed look at the effects of alcohol and how to support and treat people who are dependent, the following eLearning courses are also free to access:
RCGP Members can also find out more from the following:
Mehta, G. et al. Short term abstinence from alcohol improves insulin resistance and fatty liver phenotype in moderate drinkers [Abstract 113] Hepatology 62 (Suppl. 1), 267A (2015)