Prostate Cancer: Screening, Diagnosis and Treatment in Newcastle

Prostate cancer is the most frequently diagnosed cancer among South African men. Although many prostate cancers grow slowly, others can be aggressive and may spread if they are not identified and treated appropriately.

At Melna Oncology Centre, Dr Thandeka Buthelezi-Zulu provides specialist oncology care to patients from Newcastle, Madadeni, Osizweni, Dannhauser, Dundee, Glencoe, Utrecht, Volksrust, Ladysmith, Vryheid and surrounding communities across northern KwaZulu-Natal.

Care is based on each patient’s PSA results, biopsy findings, cancer stage, general health and personal treatment priorities.

What Is Prostate Cancer?

The prostate is a small gland located below the bladder and in front of the rectum. It surrounds part of the urethra and produces some of the fluid found in semen.

The prostate commonly enlarges as men get older. This non-cancerous condition, known as benign prostatic hyperplasia, can cause urinary symptoms similar to those sometimes associated with prostate cancer.

Prostate cancer develops when abnormal cells in the prostate begin growing uncontrollably.

The disease can behave very differently between patients. Some prostate cancers grow so slowly that careful monitoring may be more appropriate than immediate treatment. Others grow more quickly and require active treatment.

This is why prostate cancer care cannot follow a one-size-fits-all approach.

Who Is at Greater Risk?

Any man can develop prostate cancer, but risk generally increases with age.

Factors associated with a higher risk include:

• Being over the age of 50
• Being a Black African man
• Having a father, brother or son diagnosed with prostate cancer
• Having a strong family history of prostate, breast, ovarian or pancreatic cancer
• Carrying certain inherited genetic changes
• Having had a previous abnormal PSA result

A family history is especially important when a close relative was diagnosed at a younger age or when several relatives have developed related cancers.

When Should Men Discuss Screening?

Early prostate cancer frequently causes no symptoms. A man may feel completely well and still have cancer developing within the prostate.

Prostate screening commonly involves a prostate-specific antigen, or PSA, blood test. A digital rectal examination may also form part of the assessment.

South African guidance supports an informed, individual decision about screening. The Prostate Cancer Foundation of South Africa recommends that screening discussions begin:

• From approximately age 40 for Black African men
• From approximately age 40 for men with a first-degree family history of prostate or breast cancer
• From approximately age 45 for other men

These are general recommendations rather than rigid rules. The potential benefits and limitations of screening should be discussed with a healthcare professional, particularly when age, general health and life expectancy are considered.

Men experiencing urinary or other concerning symptoms require medical assessment regardless of age.

Understanding the PSA Test

PSA is a protein produced by prostate cells. A raised PSA may be associated with prostate cancer, but it is not a cancer diagnosis.

PSA may also increase because of:

• Benign prostate enlargement
• Prostate inflammation or infection
• A urinary tract infection
• Recent urinary procedures or catheterisation
• Recent ejaculation
• Cycling or pressure on the prostate
• Certain medicines and medical procedures

PSA levels also tend to change with age. Doctors therefore consider the actual result, previous results, how quickly the PSA is changing, the patient’s age, examination findings and other risk factors.

A normal PSA does not completely exclude prostate cancer, just as a raised PSA does not confirm it.

What Happens When a PSA Is Raised?

Depending on the result and the patient’s circumstances, a healthcare professional may recommend:

• Repeating the PSA test
• Checking for infection or inflammation
• Reviewing medicines and recent procedures
• Performing a digital rectal examination
• Referring the patient to a urologist
• Obtaining a prostate MRI
• Performing a prostate biopsy

A biopsy is generally required to confirm prostate cancer. Tissue samples are examined by a pathologist to determine whether cancer is present and how abnormal the cells appear.

If cancer is confirmed, additional imaging such as CT, bone or PSMA PET scanning may be recommended when clinically appropriate. Not every patient requires every scan.

Possible Symptoms of Prostate Cancer

Early prostate cancer often produces no symptoms.

When symptoms occur, they may include:

• Passing urine more frequently, particularly at night
• Difficulty starting urination
• A weak or interrupted urine stream
• Feeling that the bladder has not emptied completely
• Pain or burning when urinating
• Blood in the urine or semen
• Persistent pain in the lower back, hips or pelvis
• Unexplained weight loss
• Ongoing fatigue

These symptoms are frequently caused by non-cancerous prostate enlargement, infection or another medical condition. However, persistent or worsening symptoms should be assessed.

An inability to pass urine, heavy bleeding, severe pain or sudden weakness requires urgent medical attention.

Grade, Stage and Risk

Once prostate cancer is confirmed, doctors assess how likely it is to grow or spread.

Treatment planning may consider:

• PSA level
• Biopsy findings
• Gleason score and Grade Group
• Tumour stage
• Whether the cancer is confined to the prostate
• Whether it has reached lymph nodes, bones or other organs
• Symptoms
• Age and general health
• Personal preferences and treatment priorities

The Gleason score and Grade Group describe how abnormal the cancer cells appear and provide information about how the cancer may behave.

The stage describes how far the cancer has spread. These factors are considered together to classify the cancer’s level of risk and guide treatment.

Treatment Options for Prostate Cancer

Several effective approaches are available. Some patients require one treatment, while others benefit from a combination.

Active Surveillance

Active surveillance may be appropriate for selected low-risk cancers that are unlikely to cause immediate harm.

The cancer is monitored using PSA tests, examinations, imaging and sometimes repeat biopsies. Treatment can begin if there are signs that the disease is changing.

Active surveillance is an organised medical strategy—not the same as ignoring the cancer.

Surgery

A radical prostatectomy removes the prostate and is generally considered for selected patients with cancer that appears confined to the prostate.

Surgical recommendations are made by a urologist after considering the cancer’s risk, the patient’s health and the potential benefits and side effects.

Radiotherapy

Radiotherapy uses carefully targeted high-energy radiation to destroy cancer cells.

It may be used:

• As the main treatment for localised or locally advanced prostate cancer
• Together with hormone therapy
• Following surgery when there is concern about remaining or recurrent disease
• To treat cancer that has spread to particular areas
• To relieve pain or other symptoms caused by advanced cancer

External-beam radiotherapy and brachytherapy are among the techniques that may be considered. The appropriate approach depends on the diagnosis, available services and individual treatment plan.

Hormone Therapy

Prostate cancer frequently depends on male hormones, particularly testosterone, to grow.

Androgen-deprivation therapy reduces testosterone levels or blocks its effect on cancer cells. It may be combined with radiotherapy or used to control cancer that has spread beyond the prostate.

Possible side effects include hot flushes, tiredness, reduced sexual function, loss of muscle strength, changes in body weight and reduced bone density. Patients receiving long-term hormone therapy should be monitored and supported appropriately.

Chemotherapy

Chemotherapy may be used for advanced prostate cancer or when the disease no longer responds adequately to hormone treatment.

In selected patients, chemotherapy may also be introduced earlier alongside hormone therapy.

Other Systemic Treatments

Depending on the stage, previous treatment and molecular characteristics of the cancer, some patients may benefit from:

• Newer androgen-receptor medicines
• Targeted therapy
• Radiopharmaceutical therapy
• Bone-strengthening treatment
• Clinical trials

These treatments are not suitable for every patient and require individual specialist assessment.

What to Expect From Prostate Radiotherapy

Before external-beam radiotherapy begins, a planning scan is performed. This allows the radiation team to map the treatment area and plan how to deliver the required dose while limiting exposure to nearby structures such as the bladder and rectum.

Treatment may be delivered over several sessions. The number and schedule depend on the cancer’s stage, the radiotherapy technique and the treatment plan.

Possible side effects include:

• Tiredness
• Passing urine more frequently
• Urinary discomfort or urgency
• Temporary bowel changes
• Skin sensitivity in the treatment area
• Changes in sexual function

Side effects vary between patients and may occur during treatment or develop later. Patients should report symptoms promptly so that they can be assessed and managed.

Where radiotherapy is recommended, Melna Oncology Centre can assist with oncology assessment, treatment planning and coordination with the relevant radiotherapy service.

Life After Prostate Cancer Treatment

Follow-up care commonly includes regular PSA testing, medical appointments and assessment of any continuing or new symptoms.

Some patients experience urinary, bowel or sexual side effects after treatment. Hormone therapy may also affect energy, mood, muscle strength, weight and bone health.

Patients should feel comfortable discussing these concerns. Support may involve medication, physiotherapy, continence care, sexual-health services, exercise guidance, psychological care or referral to another appropriate professional.

A rising PSA after previous treatment does not always mean that symptoms will develop immediately, but it requires specialist assessment to determine whether further investigation or treatment is needed.

Emotional Wellbeing

Prostate cancer can affect confidence, intimate relationships, work, family responsibilities and emotional health.

Some men remain silent because they feel they must appear strong for everyone around them. Asking questions and accepting support are also forms of strength.

Patients should be given enough time to understand:

• Their diagnosis and test results
• The aim of treatment
• Available alternatives
• Possible side effects
• How treatment may affect daily life
• What follow-up care will involve

Cancer care should be compassionate, respectful and honest.

When Should You See an Oncologist?

An oncology consultation may be appropriate if:

• Prostate cancer has been confirmed
• Your urologist has recommended radiotherapy
• You require hormone therapy, chemotherapy or another systemic treatment
• The cancer has spread beyond the prostate
• Your PSA is rising after previous treatment
• You would like a second oncology opinion
• You need help understanding and comparing treatment options
• You require ongoing cancer management or surveillance

An isolated raised PSA is normally investigated initially by a GP or urologist. It does not confirm cancer by itself.

Prostate Cancer Care at Melna Oncology Centre

Dr Thandeka Buthelezi-Zulu provides specialist oncology consultations, personalised systemic cancer treatment where appropriate, treatment monitoring and ongoing follow-up.

Care is coordinated with urologists, radiologists, pathologists, radiotherapy services and other healthcare professionals according to each patient’s needs.

Access to oncology services in Newcastle can reduce some of the travel burden for patients and families from Madadeni, Osizweni, Dannhauser, Dundee, Glencoe, Utrecht, Volksrust, Ladysmith, Vryheid and the wider Amajuba District.

Frequently Asked Questions

Does a high PSA mean that I have prostate cancer?

No. A raised PSA can result from prostate enlargement, infection, inflammation and other factors. Further medical assessment is needed.

Can prostate cancer be present without symptoms?

Yes. Early prostate cancer often produces no noticeable symptoms, which is why informed screening discussions are important.

Does every prostate cancer require immediate treatment?

No. Some low-risk cancers may be safely monitored through active surveillance. Other cancers require surgery, radiotherapy, hormone therapy or another treatment.

Can prostate cancer be cured?

Many cancers confined to the prostate can be treated with curative intent. When prostate cancer has spread, treatment may control the disease, relieve symptoms and help patients live longer. Individual outcomes vary.

Can treatment affect bladder control or sexual function?

Surgery, radiotherapy and hormone therapy can affect urinary or sexual function. The likelihood and severity depend on the treatment and the individual patient. These possible effects should form part of treatment discussions.

Should men with a family history be screened earlier?

Yes. Men with a father, brother or son who has had prostate cancer should discuss earlier screening with their doctor. A family history of certain breast, ovarian or pancreatic cancers may also be relevant.

Where should I begin if I am worried about my prostate?

Start with a GP or appropriate healthcare professional for an examination and PSA discussion. If cancer is suspected, you may be referred to a urologist for further investigation. An oncologist becomes involved when cancer treatment or specialist oncology guidance is required.

Taking the Next Step

Prostate cancer is serious, but many patients have effective treatment and monitoring options. The most appropriate approach depends on the complete clinical picture—not one symptom or PSA result alone.

If you have been diagnosed with prostate cancer, have been advised to consider radiotherapy or systemic treatment, or require an oncology opinion, contact Melna Oncology Centre in Newcastle to request a consultation.

This article provides general educational information and does not replace individual medical assessment, screening advice or personalised treatment recommendations.

Sources and further reading:National Cancer Institute – Prostate Cancer Treatment, Prostate Cancer Foundation of South Africa – Screening Guidance, and CANSA – PSA Screening and Prostate Cancer.