tive explanation for the limited effect of chemotherapy on prostate cancer. Admittedly, we have not considered the intriguing possibility that much of the symptomatic improvement, palliative benefit, and perhaps even some of the survival advantage could be attributed to the pulsed corticosteroids administered with docetaxel. As they correctly point out, the available trials do not allow for the dissection of relative contributions of dexamethasone and docetaxel. Though we agree with their concerns, compelling clinical observations from many studies suggest that chemotherapy does possess clinically meaningful palliative efficacy in some patients with castration-resistant prostate cancer, and the available experience with dexamethasone alone makes it unlikely, in our view, that this accounts for the observed results of the clinical trials. Nonetheless, their concerns add to our apparently shared view that there is an urgent need to reconsider the conceptual framework on which we are developing prostate cancer therapy, and certainly underscores our sense that available therapy for castration-resistant prostate cancer has yet to pass a milestone of efficacy that would justify a sense of major accomplishment on the part of medical oncologists.