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Men who present with metastatic disease can have de novo or primary progressive disease. We characterized and compared the outcomes between these 2 groups.A retrospective cross-sectional analysis from a single institution of de novo versus primary progressive metastatic patients during a 2-year consecutive period was undertaken. Patient characteristics such as demographics, Gleason score, duration of hormone sensitivity, and treatment were obtained. The t test, Mann-Whitney U test, and Fisher exact test were used to test differences in patient and disease characteristics between the de novo and primary progressive metastatic groups. Differences in the Kaplan-Meier survival curves were compared using the log-rank test.A total of 90 patients (n = 38 with de novo and 52 with primary progressive disease) were included. Statistically significant median differences were found for the prostate-specific antigen level at the development of metastases: de novo 63.1 ng/ml vs primary progressive 12.5 ng/ml, p= <.001; albumin and hemoglobin, P = .03 and P = .045, respectively). The median duration of hormone sensitivity was 372 days (range, 54-3753 days) in the de novo group versus 1613 days (range, 7-4314 days) in the primary progressive group (P = .00006). Overall survival was worse in the de novo arm, with a median survival of 6.2 years compared with a median survival in the primary progressive group of 11.6 years (P = .027).Although the reported samples were small, our data revealed a potential difference in disease aggressiveness in those presenting with de novo metastatic cancer with higher risk disease and shorter time to castration resistance and worse survival. These data could have implications for earlier and more aggressive treatment for men presenting with de novo metastatic prostate cancer.Men who present with metastatic prostate cancer can have distant metastases as their first presentation of cancer (de novo) or develop progression to metastases after a history of curative intent therapy (primary progressive). We found that men presenting with de novo metastatic disease have a shorter duration of hormone sensitivity and worse survival compared with those with primary progressive metastatic disease, suggesting a more aggressive disease course.