OBJECTIVES: To examine bone pain and BTA utilization in patients with BMs from PC in real-world setting in Europe. METHODS: This study was conducted using the Adelphi Prostate Cancer Disease Specific Programme (DSP) 2015 database, a multi-country cross-sectional survey of 241 oncologists and 103 urologists in 6 European countries (UK, Germany, France, Italy, Spain, and Belgium). Patients’ current pain state, current analgesic use, BTA treatment, and reasons for BTA treatment data were extracted from the patient record forms (PRFs) completed by the physicians. RESULTS: A total of 3608 PRFs were collected including 1931 on PC patients with BMs. At the time of survey (an average of 15.2 months from BMs diagnosis), 41% patients experienced mild pain; and 29% had moderate/severe bone pain. The majority of the patients (96%) with pain took analgesics to manage pain, including 29% (n=387) patients who were treated with strong opioids (e.g. morphine, oxycodone etc.). Of these patients, 73% (284/387) still had moderate/severe pain. Among the patients with BMs, 74% (n=1437) were treated with a BTA, and BTA treatment occurred within 3 months of BMs diagnosis in 72% (n=1036) of them. Reasons for BTA treatment initiation within 3 months of BMs were “bone pain” (40%), “high risk of bone complications” (29%), “number of BMs” (11%), “location of BMs” (8%) and “prior history of bone complications” (5%). Reasons for not treating patients with BTA were “recent diagnosis” (36%), “low bone complication risk” (22%), and “focus on treating primary tumor” (8%). CONCLUSIONS: Bone pain is the major symptom encountered by patients with BMs from PC. The majority of these patients treated with strong opioids still experienced moderate/severe bone pain. Approximately three quarters of patients with BMs received BTAs; primary treatment goals were reductions of the risk of bone complications and associated bone pain.