Association Between Bone Pain, Survival Outcomes in Patients With mHSPC

In patients with castration-resistant prostate cancer, bone pain is commonly connected to decreased overall survival (OS). However, there is a lack of research investigating associations between bone pain and OS in patients with metastatic hormone-sensitive prostate cancer (mHSPC).

A study from Neeraj Agarwal, MD, and colleagues published in JAMA Network Open evaluated survival outcomes among patients with mHSPC according to the presence or absence of baseline bone pain upon diagnosis.

The post hoc secondary analysis reviewed the data of patients recently diagnosed with mHSPC who participated in the phase 3 SWOG-1216 study from March 2013 to July 2017.

The study’s primary end point was OS. Secondary end points included progression-free survival (PFS) and prostate-specific antigen response.

Of the 1279 participants, 301 (23.5%) reported baseline bone pain upon diagnosis, while 896 (70.1%) did not.

Dr. Agarwal and colleagues reported that patients with baseline bone pain were younger (P=.02) than those without and displayed increased high-volume disease (P<.001). They found that bone pain was also connected to decreased PFS and OS.

At a median follow-up of 4.0 years, patients who reported bone pain had a median PFS rate of 1.3 years (95% CI, 1.1-1.7) compared with 3.7 years for patients without initial bone pain (95% CI, 3.3-4.2). In patients with bone pain, the OS rate was 3.9 years (95% CI, 3.3-4.8), while OS was not reached in patients without initial bone pain (95% CI, 1.34-2.05; P<.001).

“In this post hoc secondary analysis of the SWOG-1216 randomized clinical trial, patients with baseline bone pain at mHSPC diagnosis had worse survival outcomes than those without bone pain,” the investigators wrote. “These data suggest prioritizing these patients for enrollment in clinical trials, may aid patient counseling, and indicate that the inclusion of bone pain in prognostic models of mHSPC may be warranted.”