The benefits of chemotherapy in men with symptomatic HRPC include pain relief, better physical functioning and improved quality of life. These have been well established in randomized trials. A meaningful or statistically significant improvement in survival has yet to be demonstrated. In the absence of a survival benefit, there is concern that treating men when they are free of symptoms may have a negative impact upon quality of life due to drug related toxicity. It will also limit or eliminate any therapeutic options when symptoms eventually develop and therapy is needed most.