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[M59][EU] Why the recurrence rate% is so high even with brachytherapy+external beam for prostate cancer?

I can't understand what makes cancer return even when people use brachytherapy and combine it with external beam radiation.

The external beam for the pelvis area should take care of micro-mets, no?

Let's assume person does PSMA/PET scan, maybe even PSMA/PET combined with nano-MRI which is latest discovery in terms of MRI as of 2021.

If that is the case, why are there still cases where cancer returns?

How does it form and what are the exact causes that make it return?

PS:
M59, Gleason4+3, PSA7.8, T2C.

  1. I think it's important to remember that prostate cancer is not a single tumor but rather a collection of cells that can be in the millions. The removal of the prostate hopefully captures all of the cells before they have a chance to escape. You just need a few cells to escape into your bloodstream or lymph node system and spread throughout your body. Follow up treatments may or may not be successful in finding or killing every cell. If there are multiple sites throughout your body where the prostate cancer has spread it may not be practical to treat it.

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