title: Complete androgen blockade safely allows for delay of cytotoxic chemotherapy in castration refractory prostate cancer.
abstract: OBJECTIVE
  Complete androgen blockade (CAB) does not prolong overall survival (OS) in patients with castration refractory prostate cancer (CRPC). Although there is variable clinical benefit with second-line hormone manipulation, we do not know which patients might benefit the most.
  
  
  OBJECTIVE
  To identify clinical predictors of benefit of complete androgen blockade.
  
  
  METHODS
  We reviewed the records for 54 patients who received treatment with CAB in the setting of disease progression despite castration. We evaluated progression-free survival (PFS) and OS according to PSA at diagnosis, Gleason scores, age, testosterone level, and duration of prior disease control during castration in first line treatment.
  
  
  RESULTS
  Among 54 patients who received CAB, the median PFS was 9 months (CI 4.3-13.7) and OS was 36 months (CI 24-48). We did not find an effect of PSA at diagnosis (p = 0.32), Gleason score (p = 0.91), age (p = 0.69) or disease control during castration (p = 0.87) on PFS or OS. Thirty-four patients subsequently received chemotherapy, with a mean OS of 21 months (CI 16.4-25.5, median not reached).
  
  
  CONCLUSIONS
  Age, Gleason score, PSA at diagnosis and length of disease control with castration did not affect PFS or OS. In the absence of predictors of benefit, CAB should still be considered in CRPC.
authors.affiliation: Oncology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. rkaliks@einstein.br
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Kaliks
authors.forename: Patricia
authors.initials: P
authors.lastname: Santi
authors.forename: Ana P
authors.initials: AP
authors.lastname: Cardoso
authors.forename: Auro Del
authors.initials: AD
authors.lastname: Giglio
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001938:Brazil; D002369:Castration; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D009919:Orchiectomy; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen