menu
close
The PC Journey

The Prostate Cancer Journey -
How the cancer can change and grow.

Prostate Cancer cells can change, and the cancer can grow and spread. When you are diagnosed with Prostate Cancer, you may be at any stage of the disease journey. Below is a quick view of the different stages of the disease that can develop over time and a list of possible treatment options. The information on this image are explained below. 9,10

  • Localised: The cancer is only inside the prostate gland.4
  • Locally Advanced: The cancer has spread to nearby tissue only.4
  • Metastatic: The cancer has spread to other parts of the body.4
  • Hormone-sensitive: Cancer growth can be stopped if hormones are removed / levels in the body are lowered.4
  • Castration-resistant: Cancer cells gain the ability to grow even if there are low levels of hormone in the body.4
Possible treatment options
possible treatment options
Symptoms of early-stage prostate cancer

Symptoms of early-stage prostate cancer

Early-stage, localised prostate cancer generally does not cause any symptoms. 3

Prostate cancer in its earliest stages is normally found by accident, often when men complaining about problems urinating, which is not caused by the cancer, are examined. 3

 

When the PC is regarded as locally advanced (tumour cells are very malformed, the tumour has grown, but it has not yet spread), patients may experience urinary retention, where they find it difficult to pass urine. 3

Symptoms of cancer growing or changing

One clear sign that your cancer is still active and is progressing, is a rising PSA level. The rate at which it rises (how quickly it doubles) indicates how aggressive the cancer is. 4

Another sign of disease progression is the development of symptoms. 3

Signs that Prostate Cancer is progressing (becoming advanced), but has not yet spread includes: 3,4
  • Frequent urination.
  • Urgency to urinate (have to go pee suddenly and immediately)
  • Weak, dribbling interrupted urine flow.
  • Difficulty having an erection.
  • Painful ejaculation with small amount of fluid.
  • Pain due to nerve damage.
  • Haematuria (blood in the urine).
Once the Prostate Cancer spreads to other parts of the body, symptoms may include: 3
  • Pain resulting from the cancer spreading to the bones, particularly in the pelvis and spine and down the legs.
  • Fractures.
  • Lymph nodes may be enlarged.
  • Paraplegia because the spinal cord is being pinched.
  • Lethargy / feeling very listless and low on energy. 
  • Weight loss and wasting.

Treatment options for all
stages of prostate cancer

Treatment options for all stages of prostate cancer

Before any treatment is prescribed, a few factors are considered to decide what the next steps will be. 

Your doctor will consider how old you are, other conditions you may have, how well your body is nourished, how physically active or mobile you are, how well your mind works, as well as the amount of social support you have. 5

 

The cancer itself also determines what treatment to use – some cancers are not yet regarded ‘clinically significant’ (may not yet cause impaired quality of life or death) in some patients, and such cancers are at high risk of being over-treated, causing unnecessary side effects to patients. 5

What is it?

Close monitoring with regular follow-up (every 3–6 months). Therapy and medication are started at specific signs of the disease progression, and only if life-expectancy is more than 10 years. 3,5

 

Advantages

Men are spared the side effects of therapy that they do not yet require. 3

 

Disadvantages / Side effects

None

What is it?

Surgical removal of the entire prostate, seminal vesicles (tubes) and some adjacent tissue. 3

 

Advantages

High likelihood of cure if the tumour is confined only to the prostate. Allows for more definitive staging. 3

 

Disadvantages / Side effects

Depending on the skill of the surgeon, there may be some short-term bleeding, pain, and possibly longer term reduced urinary control (leaking urine) and sexual function (impotence). 4,8

What is it?

Radioactive seeds are planted directly into the prostate, killing the cancer cells slowly. 4,5

 

Advantages

Can be done as a day-case or overnight procedure. No down-time or healing time. 3,4

 

Disadvantages / Side effects

May worsen urinary and/or bowel symptoms and cause erectile dysfunction, radiation may be transferred to those around them through very close contact. 4

What is it?

Precise killing of cancer cells with radiation or photons, by damaging the cancer cells’ DNA to stop it from growing. 4

 

Advantages

Potential cure, surgery is avoided and it can be done as Outpatient therapy. 3

 

Disadvantages / Side effects

May increase frequency of urination, dysuria (pain when urinating), diarrhoea, proctitis and tiredness. 3

What is it?

This is when one or both testicles are surgically removed. It was the first treatment used for prostate cancer, that has spread, decades ago, but is not commonly used now-a-days. 11

 

Advantages

The testosterone levels (which helps cancer cells grow), are immediately lowered by 95 - 99 %. 12

 

Disadvantages / Side effects

The procedure is permanent and irreversible. 11,12

What is it?

Medication that "switches off" the testicles and stops testosterone from being produced. Called "hormone therapy". 4,11

 

Advantages

Effective in controlling the growth of Prostate Cancer cells. 4

 

Disadvantages / Side effects

Side effects such as hot flushes loss of bone density, mood swings, weight gain, and erectile dysfunction, hyperlipidaemia (high cholesterol) insulin resistance and diabetes. 3,4

What is it?

Medicine which are used to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. 11

 

Advantages

May cause a reduction of disease symptoms, can help people live longer.  4,11

 

Disadvantages / Side effects

May cause fever and low blood cell counts (risk of infection). Fatigue and numbness / weakness in the toes and fingers, hair loss, shortness of breath, loss of appetite, loss of heart function. 4

What is it?

Medication which is used to block testosterone and other hormones from binding to, and entering the cancer cells. 11

 

Advantages

Effective at blocking the effect of hormones when used in combination with hormone-lowering treatment (ADT) and so prevent cancer cell growth. 4,11,12

 

Disadvantages / Side effects

Each product has its own side effect profile. 4

Disease monitoring, follow-up & Watchful waiting

What is watchful waiting?

What is watchful waiting?


Watchful waiting is used as a method of monitoring the growth of Prostate Cancer before any treatment is given. It is generally used in older individuals, or those with other chronic conditions that may make treatment difficult.3,5

 

How often you need to be tested will be defined by your doctor, which will be based on the status of the disease, so it may be different for each patient.5

Will I need follow-ups once I start treatment?

Will I need follow-ups once I start treatment?


Once you receive treatment, you will need to be monitored regularly to check that the treatment is working as expected, and to make sure the Prostate Cancer does not recur, progress or spread.19

Once your disease is well controlled and your doctor regard the risk of it coming back as low, you will need to have a PSA test (blood test) done every 6 to 12 months for the first five years, thereafter only once a year. If the risk is high for the Prostate Cancer to come back, your doctor may require you to have a PSA test every three months.19

A physical exam (Digital Rectum Exam) will be needed only once a year.19

It is very important to keep these appointments and never miss a test, as Prostate Cancer might not cause symptoms, so it may be growing and spreading without you being aware of it. The only way you will know you have Prostate Cancer under control, is by having a PSA test done regularly.19

Where can I have a PSA test done?

Where can I have a PSA test done?


PSA testing can be done at most local public health clinics, and testing is also offered by several non-profit organisations. Look out for Prostate Cancer drives in your area where PSA tests are offered free of charge.


A PSA test can also be done at a local laboratory, but this may be more expensive. These laboratories may require a referral letter from your doctor, so remember to arrange one before going for the test.

Questions to ask your healthcare provider

 

When you start the conversation with your healthcare professional, consider asking the following questions:

 

  • Based on my medical history, what is my prostate cancer risk and risk of developing a more severe disease?
  • At what stage is my cancer, and what does this mean for my treatment options?
  • Which factors will help determine which treatment is best for me to treat my Prostate Cancer?
  • Would I need to consult a specific specialist for the treatment you are recommending?
  • What does the treatment process/plan look like – how long will the treatment take and how long will it take to heal?
  • After I had treatment, what are my chances that the cancer will return?
  • Will the supplements or other medication I use every day have an impact on how my prescribed treatment work?
  • What benefit could I expect from the treatment being recommended to me?
  • What risks are there pertaining to the treatment prescribed for me?
  • Is there any treatment that can be prescribed to help cope with specific side effects or symptoms of the disease?
  • Will my medication be covered by my medical aid, or what would the costs be that I may have to cover?
  • Will all other costs be covered by my medical aid (doctor’s visits, laboratory tests, treatment procedures, dietician-consultation, etc)?
  • Are there any organisations or support groups that I can contact that can help me on my journey?