I have been on Lupron plus Xtandi for the past six months since rising PSA and PET scan diagnosed mets in bone and lymph nodes. I do experience hot flashes and fatigue; however, the drugs seem to be working so far. Testosterone has come down to 9 and PSA is down to 0.1. I have inquired about adding the LU-177 but can't do it because my blood counts are too low due to a blood cancer (MDS) with very low white and red cell counts. Fatigue is probably also related to anemia from the MDS. Also, I can only take half the dose of Xtandi due to its interaction with Plavix which I am currently taking for heart issue.