I think the biggest problem by far is the lack of an immediate impact on PSA or symptoms. These patients have been conditioned to think that anything that helps them fight their cancer will lower their PSA. If you read the patients boards, they are constantly cheering each other on as far as how low a new treatment drops their PSA. A lot of them are confused about Provenge because it works differently and doesn't show immediate results. Some patients I read had their PSA increase during or shortly after Provenge treatment and are questioning if Provenge actually fed the cancer instead of fighting it. Dendreon desperately needs to find a way to overcome this perception problem.