Bone Pain Is Associated with Short Radiographic Progression-Free Survival in Patients with Metastatic Castration-Sensitive Prostate Cancer.

Background: We aimed to evaluate the prognostic significance of bone pain at presentation in metastatic castration-sensitive prostate cancer (mCSPC) and its association with radiographic progression-free survival (rPFS), independent of established prognostic factors. Methods: We retrospectively analyzed 205 patients with mCSPC treated at our center. Data were obtained from patient files and hospital records. rPFS was estimated using the Kaplan-Meier method and compared using the log-rank test. Baseline characteristics according to bone pain status were compared using the χ2 test for categorical variables and the Wilcoxon test for continuous variables. Results: Median rPFS for the entire cohort was 23.8 months (95% CI: 18.6-29.0). In univariate analysis, median rPFS was significantly shorter in patients with bone pain compared to those without (16.9 vs. 29.5 months, p < 0.001). Other factors associated with worse rPFS included ECOG PS ≥ 1, DNA repair mutations, high disease volume, liver metastasis, hemoglobin < 12 g/dL, and albumin < 3.5 g/dL. In multivariate analysis, bone pain (HR = 2.37, 95% CI: 1.29-4.34; p = 0.005), albumin < 3.5 g/dL (HR = 1.99; p = 0.034), hemoglobin < 12 g/dL (HR = 2.00; p = 0.005), and liver metastasis (HR = 3.07; p = 0.024) remained independent predictors of shorter rPFS. Conclusions: Bone pain at presentation is an independent prognostic factor for shorter rPFS and may help guide risk stratification and treatment decisions in mCSPC.