Yes of course, this is one of the considerations when choosing seeding
over surgery in the first place. So far all looks fine with his PSA, and he
should believe what his doc is telling him.

When I was given the various choices when deciding how to treat my prostate
cancer, one of the things that turned me off from seeding and freezing was
that if not successful, removing the prostate was not a viable option.  It
seems it sort of "melts" to the surrounding area and removal would then
require also removing parts of the bowel.  As one of the younger guys here
(I was 47 when I had my surgery) I opted to have it removed so as to not
deal with the issues your brother is now facing.

Sandy K.

You got two good answers.  I'll add that people who choose radiation hope
for their PSA to gradually go down and level out.  If it levels out at 1.2
for so for 50 years, that's good.

Yes, it is true that you need a surgeon sho specializes in 'salvage'
surgery.   More important you need advice about whether or not such
surgery would do any good.  If the cancer has already spread beyond the
local area, surgery would be pointless except possibly to relieve symptoms.

<snip>

It would be more difficult to remove and leave no damage to the
urethra. Ergo, you would have urinary problems with extended
catherisation, possibly supra-pubic.

If it was properly radiated, I cannot see any point in removing it.
His PSA numbers are currently good without cause for concern.

Other posters here have made allusions to cancer "coming back". This
is not what happens. Cancer is always present. When you cease
suppressing it, it grows.

If you can get a PET scan, there's a big chance of detecting Mets if
your PSA doubling time is of short duration.

If Mets were present, you would then require a new treatment plan,

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I have no 1st hand experience however my brother who is surgeon and
tells me that removing a radiated prostate is a challenge and yes not
all surgeons will take this on. It called Salvage Radical
Prostatectomy. I know Dr. Eastham at Sloan Kettering does this and you
can bet that Hopkins guys can do it too.

Your brother's PSA may or may not indicate a recurrence.
Since it went down after going up, there is a decent chance
that it is not a recurrence or, to speak more precisely as
Clarence would have it, a progression of the disease.

Brachytherapy often produces "bouncing" PSA.  The PSA
usually settles down after three years, but I think some people
have bounces after that.  If I remember correctly, the standard
for PSA "failure", as opposed to bounce, is three successive
increases in PSA.

Salvage prostatectomy is possible and is done in a number
of cancer centers.  However most surgeons won't do it
because the number of side effects is high and in order
to be successful, the rising PSA must have definitely been
a local recurrence, not a metastatic one.

There was a National Cancer Institute sponsored clinical trial
underway testing salvage prostatectomy.  See:

http://www.clinicaltrials.gov/ct/show/NCT00002938?order=8

I see a notice on that page however that the trial has been
suspended but, unfortunately, I haven't been able to find out
why.  If you call some of the centers and find out, please let
us know.

Sometimes when a trial is suspended it is because early
results were bad and they decided not to subject any more
patients to the treatment.  I don't know if that was the reason
in this case.

I know that your brother must be anxious about his PSA.  Who
could blame him?  We all are.  But there are good chances that:

1. It is not a recurrence.
2. If it is a recurrence, it will be slow growing and not life
   threatening for many years.
3. If it becomes life threatening, then hormone therapy may
   block it for years.
4. New treatments may become available.

So, there is a decent chance that, no matter what, he will
die of something other than PCa.

   Alan