She refused to give me Neupogen

although my white blood cell counts were down, especially my lymphocytes, due to the (oral) chemo I was using. I had to stop the treatment while my PSA was still going down. Normally the relationship with my oncologist is good: "Just tell me what you want", but unfortunately, I am not always getting what I want. As dr. Stephen B Strum already wrote: 'Patients become frustrated with what they cannot get from their own local physician.' When I asked my oncologist what indication was required to get it: when I had fever, due to infection, and had to be hospitalized. In other words, when it is too late.

Going back to ketoconazole(Nizoral) might now be not so successful: at the ASCO 2013 yearly conference of American oncologists last month there was a poster session where they showed that the chance of a good reduction using abiraterone acetate (Zytiga) depends a lot on the level of, yes, your lymphocytes. At ASCO 2010 dr. Eric Small presented results for the combination of ketoconazole and Leukine: 75% of patients had more than 50% reduction, and 30% even more than 90%. Leukine has the same beneficial effect on the immune system and white blood cell count as Neupogen, Neulasta, and a new contender, Tevagrastim. Think of it as though your (now more potent) immune system is attacking the cancer together with the drug. The results of any drug will improve. The only problem with these is that they are expensive. Keto is just $100/month, but Leukine is $200/day.

An example I recently read on the 'professional' website www.advancedprostatecancer.net run by Joel T. Nowak: a comment placed (here you don't post a reply) by a, still full time working, urologist who himself was confronted with bone-metastatic PCa, Gleason 9. After 3 months Lupron plus Casodex he received combined Taxotere and Carboplatin for 3 months, and he took Neulasta to raise his white blood cell count. His PSA went down to 0.01, and after 20 months it was still 0.01. Nice when you can prescribe your own drugs (actually done by his colleague oncologist, but from his wording it sounds like he did it himself).

What was the reason the doctor gave?

At one time I had reason to give myself Neupogen injections every week for a few months. That stuff hits you like a truck.

Managing your medical team {doctor}, succinct and running over with truth. Tall Allen, one of my sons, is in his final year, close to his dissertation at chapel hill in epidemiology,with a stress on sports medicine. He was/is deeply involved with the concussion issue in NFL, college, high school football also. Side note from a proud dad, if you will. Any way he mentioned that a standard thesis,motto,postulate,whateva, of epidemiologists, at least , in his experience is " all models are wrong"
I think I know what that means from my minimal readings of studies, as I "see" the inconsistencies of necessities,if that makes sense. He did concur with your concept of "evidence" but not definitively. regards.

The authors said...
Moreover, the way that filgrastim is administered in real-world clinical practice (and some clinical trials) may compromise its efficacy. It should be given daily, until ANC returns to the normal range; data from registrational trials indicate that this requires approximately 9–14 injections per chemotherapy cycle. However, it is common practice to administer fewer doses than this and/or to start treatment relatively late after chemotherapy. Several analyses have shown that, when used in this manner, filgrastim may provide suboptimal protection against FN.

I think the Taxotere cycle is 3 weeks? If so, the daily Neupogen would cost 2205 euro vs 1516 euro for the Neulasta, a relative bargain for the single injection!