ABSTRACT
Purpose@#This study aimed to evaluate the impact of serum testosterone level before enzalutamide treatment in metastatic castration-resistant prostate cancer (mCRPC) for antitumor outcomes. @*Materials and Methods@#Single-center, retrospective study including patients that treated with enzalutamide for mCRPC before and after docetaxel chemotherapy. Clinicopathological parameters including serum testosterone at initial enzalutamide use were examined. Prostate-specific antigen (PSA) response, progression-free survival (PFS), and cancer-specific survival (CSS) were the outcomes of interest. Logistic-regression analysis was done for discovering odds for PSA response. Cox-proportional model was applied for risk stratification for progression and cancer-specific death. @*Results@#A total of 228 patients with mCRPC, treated with enzalutamide, both prechemotherapy and postchemotherapy, between 2011 and 2019 were included. One hundred sixty-two of patients (71.1%) experienced PSA decline over 50%. Median PFS and CSS were 5.4 and 13.2 months, respectively. Serum testosterone at initial enzalutamide use was the noble predictor for progression (hazard ratio [HR], 0.409; p=0.020) and cancer-specific death (HR, 0.454; p=0.033) in postchemotherapy group. No significant effect of serum testosterone in prechemotherapy group was detected. Time to CRPC, high-metastatic burden revealed as risk factors for PSA response, PFS, and CSS, both in prechemotherapy and postchemotherapy group. @*Conclusions@#High testosterone level at commencement of enzalutamide treatment was associated with a good prognosis in postdocetaxel setting, but not related to oncological outcomes in chemotherapy-naïve patients.