Definition of treatment failure in patients with prostate cancer: subjective versus objective parameters

Biochemical or other objective evidence of disease progression may precede symptomatic relapse in patients with prostate cancer by many years. It is important, then, to define the intent of therapeutic intervention. Strategies to prolong survival may be most effective when implemented early in the course of the disease and with minimal tumor bulk. On the other hand, intervention aimed at prophylaxis for symptomatic events is rarely justified. Many treatment initiatives that aim toward improved quality of life do not have an identifiable salutary effect on duration of survival. Some of the uncertainties surrounding the definition of disease progression can be eliminated by defining accurately the goal of therapy.