Many men who are told their surgery for prostate cancer has been a success later discover that this is not the case. The level of a protein in their blood, called prostate specific antigen, PSA, begins to rise signalling they still have prostate cells in their body even though they were told the entire prostate had been removed.
There has been long standing debate about how best to predict who will fail after surgery. The current debate focuses on the value of pathologists examining the excised prostate and trying to detect, under the microscope, whether tumour cells have invaded the lymph and blood systems.
This is called lympho-vascular invasion, or LVI, and means malignant cells that have invaded these systems can then be transported onwards to other parts of the body. They may implant themselves, as micro-metastases, in places such as the lung or spine, and slowly replicate to form a new tumour in that site.