Refractory disease, new horizons and patient-physician relationships.

Understanding the role of chemotherapy for prostate cancer has advanced along two axes, better definition of endpoints, and biologic understanding of disease targets. Use of PSA as a surrogate endpoint makes possible the more rational design of phase III trials which will include survival and disease free intervals as an endpoint. Pain control has emerged as an important treatment endpoint through which more cost-effective care can be envisioned. Discovery of growth factor interactions with prostate cancer cells and the elucidation of apoptotic pathways have provided numerous new targets for biologic and chemotherapy of advanced disease.