Question:what do you do when the prostate cancer comes back? Did it ever leave?

From The Decision:

a small amount of cancer got out of the prostate before the treatment got there, so it never really left at all.

• Patients often ask about the cancer coming back.  If the prostate is removed and the cancer is already “silently” in a lymph node or just outside the prostate, then cancer is still in the body after the prostate is removed.
• The way you know this has happened is that the PSA will slowly rise “after” the prostatectomy.
• So the cancer did not come back, it was outside the prostate at the time of the surgery.
• If the cancer “comes back” after radiation, well that is a bit different.
• There is always a chance that the radiation did not “kill” all the cancer cell. In the case of external beam, maybe the dose was not strong enough. In the case of seeds, maybe a “skip’ area where the activity of the seeds missed a spot.
• In radiation, there is always the chance as well that as well, the cancer was outside the gland before the treatment.

So, did the cancer come back…or was it there all along. I speak a lot about luck in the treatment of prostate cancer. you’re lucky if your Gleason’s is low, your disease volume is low, and confined to the prostate.