‘What happens next?’ An exploration of how general practitioners talk to men presenting with possible symptoms of prostate cancer

Prostate cancer is the most common form of cancer amongst men in the UK. It is also the second most common cause of death in the UK. The strongest risk factors for developing the condition are increased age, family history and African-Caribbean ethnicity. Detection methods have problems with reliability, specificity and being unpleasant. Further, there are debates about the effectiveness of treatments. Treatments are also associated with a number of temporary or long term side effects, including erectile dysfunction and incontinence. Issues related to masculinity and how men are often unwilling to seek help or delay in presenting to general practitioners further complicate detection and treatment. NICE (2008) recommend that decisions about testing are made on an individual by individual basis. It is recommended that general practitioners advise men about issues of detection in order for them to make an informed decision about testing. This study aimed to explore how general practitioners approach such conversations and issues related to the construct of masculinity. Semi structured interviews were completed with 14 general practitioners in the UK. Data were analysed using thematic analysis. Overall, participants had a number of different approaches and strategies to managing conversations. Four overarching themes were identified, ‘dilemmas and differences’, ‘being men’, ‘awareness, action and assertiveness’ and ‘significance of gender and age’. Participants described how issues related to masculinity might have impacted whether men sought help. However, adopting a proactive approach and coming from higher socio-economic status may have modified these. General practitioners may benefit from further training about managing uncertainties around detection and treatment given the increased emphasis on primary care involvement following treatment for cancer in secondary care. Further research involving examination of live consultations may be useful to gain another perspective on how general practitioners manage such conversations