There is no consensus about the best systemic treatment for hormonally resistant prostate cancer. Several regimens have been examined; none of them have demonstrated a consistent increase in overall survival. The treatment of hormonally resistant prostate cancer is therefore palliative. Recent studies in Canada have taken the approach that the best way to measure disease palliation is to assess the effects of therapy on disease-related symptoms and quality of life. Studies with mitoxantrone and prednisone confirm that this regimen is well tolerated and leads to symptomatic improvement in approximately 40% of patients, with a median duration of improvement of more than 10 months. This is greater than that achieved with prednisone alone. Treatments that have greater activity against hormonally resistant disease are urgently needed, although improvements probably will be gradual and modest. While it may be appealing to intensity treatments to obtain greater efficacy, there is a real risk that the toxicity will nullify any benefits. This approach of directly measuring the ability of systemic therapies to provide palliation is an appropriate way to assess newer therapies for hormonally resistant prostate cancer.