My 66 yr old husband, diagnosed 3 years ago now has had stage IV prostate cancer for 14 months. He has had the seeds implanted, hormone theraphy, targeted radiation, and just finished a year of chemo with taxotere and steroids. His PSA had fallen from 1500 to 400 in 10 months but has begun rising again as chemo is no longer effective. His Dr is evaluating the next treatment. He also has complications from a stroke 10 months ago, Parkinsons Disease, COPD, diabetes, and sleep apnea. He wants to go into a clinical trial if one can be found, but I wonder if all his other health issues plus being on Coumadin would keep him from any study.  His oncologist thinks a trial study may be too much for my husband to deal with. He has also had to increase his pain medication for bone pain. He is always tired or dozing and his appetite is nearly nonexistant. We know his treatment is pallative, but we don't know at what point we should begin talking about end of life care or what point is turning toward the end of his life.  What should we be asking his doctor and what end time are we looking at?