Purpose:To further assess preclinical and early clinical evidence that imatinib mesylate, a plateletderived growth factor receptor (PDGFR) inhibitor, modulates taxane activity in prostate cancer and bone metastases, a randomized study was conducted. Experimental Design: Men with progressive castration-resistant prostate cancer with bone metastases (n = 144) were planned for equal randomization to i.v. 30 mg/m 2 docetaxel on days 1, 8, 15, and 22 every 42 days with 600 mg imatinib daily or placebo, for an improvement in median progression-free survival from 4.5 to 7.5 months (two-sided a = 0.05 and b = 0.20). Secondary end points included differential toxicity and bone turnover markers, tumor phosphorylated PDGFR (p-PDGFR) expression, and modulation of p-PDGFR in peripheral blood leukocytes. Results: Accrual was halted early because of adverse gastrointestinal events. Among 116 evaluable men (57 docetaxel + imatinib; 59 docetaxel + placebo), respective median times to progression were 4.2 months (95% confidence interval, 3.1-7.5) and 4.2 months (95% confidence interval, 3.0-6.8; P = 0.58, log-rank test). Excess grade 3 toxicities (n = 23) in the docetaxel + imatinib group were principally fatigue and gastrointestinal. Tumor p-PDGFR expression was observed in 12 of 14 (86%) evaluable bone specimens. In peripheral blood leukocytes, p-PDGFR reduction was more likely in docetaxel + imatinib^treated patients compared with docetaxel + placebo (P < 0.0001), as were reductions in urine N-telopeptides (P = 0.004) but not serum bone-specific alkaline phosphatase (P = 0.099). Conclusions: These clinical and translational results question the value of PDGFR inhibition with taxane chemotherapy in prostate cancer bone metastases and are at variance with the preclinical studies. This discordance requires explanation.The metastatic phenotype of prostate cancer is highly conserved and characterized by osteoblastic bone metastases, the burden of which correlates with morbidity and mortality from the disease (1). Clarification of the molecular basis of disease progression in bone is expected to yield therapeutic strategies that may significantly transform the natural history of the disease.Several lines of evidence have implicated the platelet-derived growth factor receptor (PDGFR) in the progression of prostate cancer bone metastases. Amplification of conserved domains of tyrosine kinase receptors using degenerate primers identified PDGFR as the most commonly amplified transcript from pooled aspirate specimens from prostate cancer bone metastases (2). Immunohistochemical staining has shown high frequencies of PDGFR expression in prostate cancer bone metastases (2, 3). Our preclinical findings from an orthotopic model of prostate cancer bone metastases showed that PDGFR expression was up-regulated in PC3-MM2 cells and associated vascular endothelium within the bone microenvironment, suggestive of an organ-specific paracrine effect (4). Further, combining the PDGFR inhibitor imatinib mesylate (5) with