A PCa Warrior's Continuing Battle Part I

A recent e-mail to my trusted advisers appears below:
A year ago my Casodex became ineffective. I scrambled to determine what to do next. After much hand-wringing, worry and concern  I settled on Xtandi which has effectively controlled my PSA at < 0.01 since March 11, 2017. 

My goal at this point is to develop a plan of action for the inevitable point in time when Xtandi loses its effectiveness. As one of my trusted advisers I would be grateful for your assistance in this effort. The following modalities occur to me as worthy of serious consideration:

--Pencil beam PBRT as practiced by Dr Carl Rossi at Scripps Proton Radiation Center

--Lupron as recommended by the two Michigan medical oncologists I consulted following Dr Myers retirement

--Chemotherapy as practiced by Dr. Bob Liebowitz at Compassionate Oncology Medical Group or by Dr. Kwon of Mayo Clinic

--Targeted high dose brachytherapy as practiced by Dr. Marissa Kollmeier at the Westchester N. Y. Branch of Sloan Kettering in Manhattan.

A brief summary of my treatment history appears below for your convenience:

2005 to 2008  PSA  rose from 1.39 ( Apr. 8) to 3.97 ( Sept. 4 )

2008 Diagnosed with PCa. Two cores positive, Gleason 4+3

2009 Completed PBRT at UFPTI on March 11.  PSA  dropped to .8. UFPTI reviewed my biopsy slide and agreed with Gleason 4+3 determination

2012  PSA  rose from .8 to 2.59 from May to Oct.; Dr. Kwon of Mayo Clinic  identified a small cancerous lesion in  prostate by Choline Scan. Mayo Clinic reviewed  my biopsy slide and determined my Gleason to be 4+4 

2013  Began Hormone Lite as prescribed by Dr. Charles Myers; primary anti-cancer med. was Casodex.

2015

  I.PSA rose from .077 in Jan. to .18 in Aug. Dr. Myers increased my Casodex  from three times weekly to a daily dosage. PSAs returned to their former lower levels.

  II. Endorectal MRI at VCU; 3x5 mm tumor identified

2016  PSAs ascend from .11 in Apr to .49 in Dec. Follow-up endorectal MRI at VCU; tumor more than doubled in size to 10x7 mm .

2017 After a fair amount of research and consternation Dr. Myers and I agreed to modify my protocol with the major change being a switch from Casodex to Xtandi.  My PSA dropped to < 0.01 in about two months and has remained at this level to date.
 <0 .10="" about="" and="" at="" date.="" has="" in="" level="" months="" p="" remained="" this="" to="" two="">Current age 81*..

Part II will summarize responses from my trusted advisers (et. al.?)

Stay tuned.
*This site will not permit me to enter the needed correction. Sorry!