PSA scare

The first step has to be to eliminate other reasons that your PSA never went down after brachytherapy. Possible reasons are (listed in order of decreasing likelihood):

1. Urethral stricture - If you have a urethral stricture from the brachytherapy and consequent urinary retention, which is very common after brachytherapy, it could be artificially inflating your PSA. Are you having problems emptying your bladder? slow stream? have to go frequently? Have you had a cystoscopy or did the CT or MRI reveal any blockage?

2. Prostatitis - If your prostate is chronically inflamed, it will elevate your PSA. If so, you may have symptoms like a stricture, or it may be symptomless. If you're lucky, a course of antibiotics may take care of it, but more likely it won't. Worth a try anyway.

3. Inadequate/poor seed placement - This can occur for several reasons, including the skill of the brachytherapist,seed displacement after insertion, prostate swelling, prostate too large or too small, and failure to do a one-month follow-up. If this is the case, it would be obvious on the CT scan. I suggest you get a second reading and opinion on the CT scan by a brachy expert, like Steven Frank at MD Anderson in Houston. Just tell your doctor to send him the scan and your brachytherapy treatment details for a second opinion.

4. Brachy didn't kill the cancer - sometimes the cancer is resistant to radiation because there is a "hypoxic" area around the tumor. A biopsy may be able to identify such areas, and they can simply be treated with more radiation (HDR brachy or SBRT to get the dose high enough).

The problem with a biopsy is the difficulty reading it. Cancer cells only die when they try to replicate, so how can one determine whether a cancerous area is on its way to being killed off, or hasn't been killed? Perhaps Steven Frank can answer that - another reason to get a second opinion from him.

I would certainly want to try the more conservative measures first - cystoscopy, antibiotics, and second opinion - before I did anything invasive like a biopsy, or salvage SBRT or HDR brachy, and certainly not salvage surgery. If it turns out that you should need salvage SBRT radiation, Dallas is a great place for it. But before I go into that, let's see what the other approaches tell you.

It may be related if you have a bacterial infection that worked its way from or to the prostate. Did you take antibiotics for it, and take a PSA test afterwards?

I saw in your other thread you are looking for a Dr. in Dallas. I can't recommend one there but I can in San Antonio. Dr. Sarosdy http://www.drsarosdy.com/

He's the former Chairman of Urology at the UT Health Science Center in San Antonio. Although I am only 6 months into my treatment he has done well by me so far.

Good luck!