I started Xtandi August 15, PSA 5.35. My PSA on October 13 was down to 2.04. So it seems to be working. Side effects have gotten worse , extreme fatigue, mild nausea, severe bloating and gas and shortness of breath on exertion. For pain management, I am now on 72 hour Fetanyl patch 50mcg/hr plus Hydromorphone 2mg every 2 hours, and 220 mg Naproxen sodium each morning. This generally keeps pain below level 4. Still experiencing short spikes of pain to, level 8 or 9, in ribs and spine if I move wrong. Quality of life has declined but still able to do most daily activities and play bocce most mornings. Only able to walk or stand about 5 to 10 minutes at a time without increased pain. I am now 18 years out since diagnosis in1999. I have recently given in and gotten a handicapped parking sticker and using an electric scooter for shopping. I hope this is helpful to others on this journey abou what to expect. A summary of my treatments and progress since diagnosis is in my profile. May the force be with you.