OBJECTIVES: We evaluated the economic burden of treating skeletal-related events (SREs), including pathologic fractures (PF), spinal cord compression (SCC), radiation to bone (RB) and bone surgery (BS), in prostate cancer (PC) patients with bone metastasis (BM). METHODS: PC patients with a BM diagnosis between 01/01/2005 and 03/01/2012 were identified in the Truven Health Analytics databases. Propensity score was used to match BM patients with SREs to those without.  A pseudo-SRE date was assigned to the control group that was parallel to the SRE date of the matched SRE patients. We compared the total and per member per month (PMPM) costs of patients between two groups for the 6-month post-SRE/ pseudo-SRE date. RESULTS: We identified 4,975 PC men with BM where 910 patients with SREs were 1:1 matched to the non-SRE patients. For those men with at least one SRE, 95.8% received RB; 17.6% had PF; 12% received BS; and 10.4% had SCC. On average, the total 6-month costs of treating patients with SREs were $47,724, compared to $24,729 for the matched control cohort (p<0.001). The mean PMPM cost for non-SRE patients was $4,122. The largest proportion of differences in costs between two groups incurred in the first month after the SRE-index date ($16,564 vs. $4,636, p<0.001), and were mostly attributable to outpatient visits (65.7%, p<0.001) and inpatient hospitalization (29.1%, p<0.001).  CONCLUSIONS: For PC patients with BM, costs of treating those with SREs are significantly higher than comparable patients without SREs. Most of costs were incurred in the first month after the occurrence of SREs, but while costs decreased thereafter, they remained significantly higher for patients with SRE in subsequent months.