Evaluating the association between bone pain and radiologic progression-free survival (rPFS) in patients with metastatic castration-sensitive prostate cancer (mCSPC).
Authors: Tural Deniz , Kapar Caner , Şahin Selçuk , Şeker Kamil Gökhan , Tuğcu Volkan 
Published: February 2025

94

Background:
Previous studies have shown bone pain to be associated with worse survival in patients with metastatic castration-resistant prostate cancer (mCRPC). However, there are few data regarding bone pain and survival outcomes in patients with (mCSPC). In the current study, we evaluated the association between bone pain and rPFS in patients treated with mCSPC.
Methods:
rPFS were estimated by using the Kaplan-Meier method and the log-rank test was used for the comparison between different subgroups. Differences in baseline characteristics by bone pain status at mHSPC were evaluated with χ2 test for categorical variables.
Results:
Data from 205 patients were analyzed. A detail of the patient’s characteristics is shown (Table).The median rPFS for all populations was calculated as 24 mo. In univariate analysis, the median rPFS were 17 vs 29.5 mo in patients with bone pain presentations vs none-pain (p=0.001), 29 vs 20 mo in patients with ECOG PS 0 or 1≥ (p=0.09), 22 vs 14 mo in patients with DNA repair mutations absent and present(p=0.06), 27 mo vs 19 mo in patients with low volume presentation vs high volume (p=0.05), 15 vs 25 months in patients with or without liver metastases (p=0.003), 17 mo vs 27 mo in patients with hemoglobin levels <12 gr/dL or higher (p=0.002), respectively. In multivariate analysis, bone pain (HR 1.9; 95% CI 1.2-3.1; p:0.001), hemoglobin<12 gr/dL (HR 2; 95% CI 1.9 -3.1; p:0.005) were found to be an independent determinant of short rPFS.
Conclusions:
Bone pain is associated with short rPFS in mCSPC. The current study showed bone pain needs to be selected in the treatment choice or prognostic model in mCSPC.

Baseline characteristics of patients.

Variable

Patients
Presence of bone pain Absence of bone pain
(n=104) (n=101)

p value

ECOG performance status,
n(%), p
0 ≥1

34 (%32.7)70 (%67.3)
67 (%66.3)34 (%33.7)

<0,001

Gleason score at diagnosis,
n(%), p
<8 ≥8 Unknown

31 (%29.8)66 (%63.5)7 (%6.7)
34 (%33.7)65 (%64.4)2 (%1.9)
0,723

Under/over 70 years old,
n(%), p
<70 years ≥70 years

40 (%38.5)64 (%61.5)
47 (%46.5)54 (%53.5)
0,242

High/low volume disease,
n(%), p
High volume Low volume

76 (%73.1)28 (%26.9)
29 (%28.7)72 (%71.3)

<0,001

Metastasis at diagnosis,
n(%), p
Yes No

79 (%76)25 (%24)
64 (%63.4)37 (%36.6)

0,050

Metachronous metastasis,
n(%), p
Yes No

25 (%24)79 (%76)
36 (%35.6)65 (%64.4)
0,069

Liver metastasis at diagnosis,
n(%), p
Yes No

9 (%8.7)95 (%91.3)
0 (%0)101 (%100)

0,002

DNA repair mutation,
n(%), p
Positive Negative Unknown

10 (%9.6)38 (%36.5)56 (%53.9)
5 (%5)38 (%37.6)58 (%57.4)
0,436

Hemoglobin levels,
n(%), p
<12 gr/dL ≥12 gr/dL Unknown

30 (%28.8)61 (%58.7)13 (%12.5)
20 (%19.8)74 (%73.3)7 (%6.9)
0,073

PSA levels,
n(%), p
<17 ng/ml ≥17 ng/ml

46 (%44.2)58 (%55.8)
56 (%55.4)45 (%44.6)
0,094

First line treatment

0.08

Androgen receptor pathway inhibitor
43 (%41.3)
45 (%44.6)

Only ADT
34 (%32.7)
42 (%41.6)

Docetaxel
27 (%26)
14 (%13.8)