ABSTRACT Background Metastatic hormone‐sensitive prostate cancer (mHSPC) remains clinically heterogeneous despite upfront treatment intensification. The commonly used CHAARTED high‐volume and LATITUDE high‐risk criteria stratify metastatic burden but do not explicitly incorporate Eastern Cooperative Oncology Group (ECOG) performance status (PS). We developed and internally assessed a simple bedside prognostic score integrating PS with aggressive metastatic burden in a real‐world mHSPC cohort. Methods We retrospectively identified consecutive patients with histologically confirmed prostate adenocarcinoma who initiated first‐line androgen deprivation therapy (ADT)–based systemic therapy for mHSPC between January 2014 and May 2025. Metastases were assessed primarily by conventional imaging (bone scintigraphy and computed tomography CT). The PS–Metastatic Burden score (0–2) assigned 1 point each for ECOG PS ≥ 1 and for aggressive metastatic burden defined as bone scan extent of disease (EOD) ≥ 3 and/or liver metastasis. The primary endpoint was overall survival (OS). Model fit and discrimination were compared with CHAARTED and LATITUDE using Akaike information criterion (AIC) and Harrell's concordance index (C‐index) in a common complete‐case dataset. Results Among 886 patients (median follow‐up 36.9 months), 218 deaths occurred. Score distribution was 0/1/2 points in 592 (66.8%)/257 (29.0%)/37 (4.2%). OS was clearly separated across groups (log‐rank p < 0.001): median OS was not reached for score 0 during follow‐up; it was 49.0 months for score 1, and 37.3 months for score 2. In complete cases ( n = 869; deaths = 211), hazard ratios versus score 0 were 2.16 (95% confidence interval CI 1.62–2.87) for score 1 and 3.08 (95% CI 1.87–5.08) for score 2 (both p < 0.001). The PS–Metastatic Burden score showed superior performance (AIC 2513.2; C‐index 0.600) compared with CHAARTED and LATITUDE; adding PS to those frameworks improved performance modestly but remained inferior. Upfront androgen receptor pathway inhibitor (ARPI) use was lower in ECOG PS ≥ 1 than PS 0 (38.4% vs 60.8%; p < 0.001), and best supportive care initiation or death increased stepwise across score groups (21.3%, 37.2%, 51.4%). Conclusions A two‐factor bedside score integrating host reserve and aggressive metastatic burden provides pragmatic prognostic stratification for real‐world mHSPC in the upfront ARPI era and offers information beyond CHAARTED/LATITUDE. External validation is warranted.
Kurokawa et al. (Tue,) studied this question.