Evaluating the association between bone pain and radiologic progression-free survival (rPFS) in patients with metastatic castration-sensitive prostate cancer (mCSPC).
Authors: Deniz Tural, Caner Kapar, Selçuk Şahin, Kamil Gökhan Şeker, Volkan Tuğcu
Journal: Journal of Clinical Oncology (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 &lt;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&lt;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) &lt;0,001 Gleason score at diagnosis, n(%), p &lt;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 &lt;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) &lt;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 &lt;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 &lt;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)