Refractory disease, new horizons and patient-physician relationships

Understanding the role of chemotherapy for prostate cancer has advanced alo ng 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 diseas e free intervals as an endpoint. Pain control has emerged as an important t reatment 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 b iologic and chemotherapy of advanced disease.