Men with metastatic hormone-sensitive prostate cancer who experience baseline bone pain have worse survival outcomes despite treatment intensification.
Research findings presented at the 2024 ASCO Genitourinary Symposium revealed the significance of baseline bone pain as a prognostic marker for overall survival (OS) in men with metastatic hormone-sensitive prostate cancer (mHSPC). While previous studies have shown the correlation between pain from bone metastasis and OS in men with castration-resistant prostate cancer, study author Georges Gebrael, MD, and colleagues wrote that its impact in men with mHSPC remains underexplored. The authors aimed to understand if baseline bone pain would be a significant prognostic factor for OS in men with mHSPC.
For the study, the researchers analyzed patient-level data from the SWOG 1216 trial, which randomized men with mHSPC to receive androgen deprivation therapy (ADT) with orteronel or bicalutamide. They categorized patients into two cohorts based on the presence or absence of baseline bone pain (BP1 and BP0, respectively) and evaluated progression-free survival (PFS) and OS.
To determine PFS and OS, researchers conducted multivariable analyses to adjust for various prognostic factors including treatment arm, disease burden, Gleason score, log-transformed PSA, and age.
Based on the study criteria, researchers identified and included 1,279 study participants. Among those participants, 23.5% were in the BP1 cohort, 70.51% were in the BP0 cohort, and bone pain status was unavailable for 6.4% of participants.
The BP1 cohort had a lower median age and higher disease burden compared with the BP0 cohort. The research team found that men in the BP0 cohort had significantly better median PFS and OS than those in the BP1 cohort. Importantly, after adjusting for other prognostic variables, baseline bone pain remained significantly associated with decreased PFS and OS.
“Men with mHSPC with bone pain at baseline have worse survival outcomes despite treatment intensification and may be prioritized for enrollment in clinical trials,” Dr. Gebreal and colleagues wrote. “These data may aid patient counseling and warrant the inclusion of bone pain in the prognostic models of mHSPC.”
