"Old methods and thinking die hard...?"
No, going right to chemo is the current consensus for patients with rapidly progressing disease. The thought is that it takes time for provenge to kick in and the patient can't wait that long. In my experience that is because the docs waited too long in the first place and the patient has symptoms. I think adding provenge to chemo and not excluding provenge is the way to go. Those patients require multi modality therapy. Thats one reason why we need sequencing data.
A case like this is one that should be discussed in national forums to show that.
Remember provenge barely missed stat sig for relapse free survival. Man of those patients showed delayed responses and still had to be counted as failures to respond. In addition as I said before, patients with high gleason scores and aggressive disease benefited as well.