My experience & knowledge of Acrobat Distiller is [a] at work (PC, not Mac) and [b] used almost exclusively with MS Word, but occasionally with Excel.

I'm pretty sure my employer had to buy Distiller; I don't believe that it "comes with" any word-processing or other program. I don't know the cost, but I do know that, unlike Acrobat Reader, it's not free.

Once you have purchased and installed Distiller, it functions as a virtual printer. Whenever you opt to print from Word (or Excel, or Publisher, or another program), "Acrobat Distiller" appears in the print dialog box as a selection on the dropdown list of printers. When you select Distiller and click the [Print] button, you get a prompt to name the PDF file about to be created; hit [OK] and the file is created.

I don't know for sure that Distiller can be used with Pagemaker or any other specific application, but I don't see why not, since Distiller is recognized by Windows as just another printer.

There is no direct interface with the software that created the "source" document to be converted to a PDF; the commection that exists is via the operating system's print function, which is used with virtually every program on the computer. Any PC program from which a printed copy can be generated via the standard Windows print dialog box should be compatible with Distiller, and I have no doubt that the Mac handles things pretty much the same way.