PSA Rising: NOW What??

I have metastatic castrate-resistant prostate cancer.  Brief summary follows, with details on my "About Me" page:

Journey started April 2013.  Had radical prostatectomy in June 2013. At time of surgery, cancer also found in 4 of 12 extracted lymph nodes.  But when PSA began rising in fall of 2013, I have followed that surgery up with the following:

• 7 weeks pelvic bed radiation therapy,
• hormone deprivation therapy,
• XOFIGO radiation injection therapy,
• phase 3 clinical trial participation combining Xtandi and Tecentriq (failed),
• chemotherapy w/Taxotere (bad allergic reaction) and
• now about to have 7th Jevtana infusion (tomorrow) ....

Throughout all this, starting in April 2017, various scans showed mets throughout skeletal area from thighs through spine, ribs & shoulders. 

• PSA rose all the way to 312 in February this year (so then started chemo). 
• PSA then decreased all the way to 40.1 by July 18th. 
• PSA INCREASED to 59.4 on August 7th.

So .... what now???  I will be visiting with medical oncologist tomorrow ...... 

(Since March, I have been taking methadone 10mg twice daily & prednisone 10mg daily.  Fortunately, throughout all this, I am feeling good, I have had very little pain if any at all, & I am able to do most anything.   I aggressively walk 4 miles daily.)