I had a rising PSA a few years after Proton radiation treatment. PET scan shows some mets so started Lupron plus Xtandi (160 mg per day) treatments 18 months ago. PSA dropped to zero or near zero within a 3 months after starting treatments. It is working well so don't plan to change anything at this point; however, I do suffer the typical side effects of fatigue and hot flashes. Hot flashed are mostly controlled with an additional pill.