Abstract
e16049 Background: Recent development of new second line therapies in patients with CRPC upon progression to docetaxel has raised the question of who benefit most of either a salvage hormonal treatment (HT) or chemotherapy. Objectives: To analyze the prognostic value for survival of the absolute levels of serum testosterone (TL) in patients under definition of CRPC (PSA and/or clinical progression with a TL <50 ng/dL). To analyze the probability of response to salvage HT upon failure to docetaxel. Methods: 101 patients with metastatic CRPC were included in 9 different non-hormonal first line phase II-III trials in two single institutions from August 2006 until September 2012. Inclusion criteria of those trials required castrate levels of testosterone. TL was determined by automated immunoassay. Survival was calculated since the date of entrance in the trial to death. Results: Median age was 70 years (41-89). 22% of the patients had visceral metastases. Median PSA was 51 U/L (0.04-1284). Median Hemoglobin was 13 g/dL (9.3-15.6). Median TL was 11.53 ng/dL (range undetectable to 48.9). First line chemotherapy was Docetaxel (alone or in combination) in 71/101 patients (70%). Median overall survival (OS) was 24.51 months. Patients with TL under median value (N=49) had an OS of 22.4 months, compared to 32.7 months in those whose TL was higher (N=52) (p=0.0162 , HR 0.52). Anemia (Yes vs NO) was an adverse prognostic factor (OS 20.6 vs 28.4 months, p=0.0025, HR 2.4). Patients presenting both factors (anemia and lower TL) had a worse outcome compared to those who had only one or none of them (OS: 17.9 vs 22.4 vs 38.1 m; p=0.0024). 41 patients (40.6%) were treated with salvage hormone therapy after chemotherapy failure. Baseline TL was associated with PSA response to salvage HT. Only 5/23 patients (21.74%) with TL below median value showed PSA response, vs 10/18 (55.6%) if TL was over median value. Conclusions: Testosterone even under castration level (< 50 ng/dL) was a prognostic factor for survival in patients with metastatic CRPC. PSA response to salvage hormonotherapy differed depending on testosterone levels. TL could help us in treatment decision after first line chemotherapy failure.
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