The dramatic success of docetaxel in the Stampede trial depended on the man being hormone naive - it wasn't about being castrate dependent or castrate independent. There are years and years of evidence that prostate cancer becomes resistant to docetaxel at some point so if it isn't introduced while the man is still castrate naive it is simply reducing his options later down the line. Also, other trials have shown that a) half of prostate cancers are docetaxel resistant and b) chemo can cause chemical changes in the cancer cells (e.g. cribriform pattern) which make them more resistant to other treatments. That is why, until Stampede, chemo was only used at the end of life stage.
The issue with paying up front for abi is two fold - not only do you have to fund the actual tablets but also all appointments, blood tests and other monitoring tests for the duration and you are unlikely to be able to revert to NHS at a later date. Abi doesn't last very long for many men so funding it for 8-10 months might be achievable but if he is one of the lucky ones, would you be able to fund it for 4 years? I'm not saying don't do it, just things to consider.
A second opinion is usually very easy - you just ask to be referred to a different oncologist for a consultation. How easy it will be during COVID, I don't know.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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