Clinical Burden and Inpatient Outcomes of Metastatic Versus Non-Metastatic Prostate Cancer: Analysis of the National Inpatient Sample

Background: Metastatic prostate cancer (mPC) carries substantial clinical and economic burden, but its comparative inpatient outcomes relative to non-metastatic disease (nmPC) remain incompletely characterized using contemporary, nationally representative data. Methods: We performed a retrospective, cross-sectional analysis of the 2021–2022 National Inpatient Sample, identifying non-elective prostate cancer hospitalizations in adults ≥ 18 years and classifying them based on metastatic status using ICD-10-CM coding. Multivariable logistic and linear regression models evaluated independent associations of metastatic status with in-hospital mortality, length of stay, and total hospital cost. Results: Among 285,495 prostate cancer hospitalizations, 44.5% had metastatic prostate cancer. In-hospital mortality was higher among mPC hospitalizations (7.14% vs. 4.61%; adjusted OR 1.57, 95% CI 1.45–1.69), strengthening after adjustment for in-hospital complications (aOR 1.94, 95% CI 1.77–2.11). mPC was associated with longer length of stay (+ 0.48 days) and higher total cost (+$495.91), greater palliative care use (19.43% vs. 7.10%), and less frequent routine home discharge (38.05% vs. 49.72%). Conclusion: Metastatic prostate cancer is independently associated with greater in-hospital mortality, resource utilization, and post-acute care needs compared with non-metastatic disease, even after accounting for in-hospital complications, underscoring the need for early palliative integration and equitable access to subspecialty care.