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.