Pain and its association with survival for Black and White individuals with advanced prostate cancer in the US.

Bone pain is a well-known quality of life detriment for individuals with prostate cancer and is associated with survival. This study expands previous work into racial differences in multiple patient-reported dimensions of pain and the association between baseline and longitudinal pain and mortality. This is a prospective cohort study of individuals with newly diagnosed advanced prostate cancer enrolled in the International Registry for Men with Advanced Prostate Cancer (IRONMAN) from 2017-2023 at US sites. Differences in four pain scores at study enrollment by race were investigated. Cox proportional hazards models and joint longitudinal survival models were fit for each of the scale scores to estimate hazard ratios and 95% confidence intervals for the association with all-cause mortality. The cohort included 879 individuals (20% self-identifying as Black) enrolled at 38 US sites. Black participants had worse pain at baseline compared to White participants, most notably a higher average pain rating (mean 3.1 vs 2.2 on a 10-point scale). For each pain scale, higher pain was associated with higher mortality after adjusting for measures of disease burden, particularly for severe bone pain compared to no pain (HR of 2.47; 95% CI 1.44, 4.22). The association between pain and all-cause mortality was stronger for participants with castration-resistant prostate cancer compared to those with metastatic hormone-sensitive prostate cancer and was similar among Black and White participants. Overall, Black participants reported worse pain than White participants, and more severe pain was associated with higher mortality independent of clinical covariates for all pain scales.