OBJECTIVES: With the introduction of new agents for metastatic castration-resistant prostate cancer (mCRPC), we aimed to document real-world changes in first line treatment in Germany. METHODS: This was a retrospective observational study using German claims data. We identified adult patients with at least one inpatient or two confirmed outpatient prostate cancer (PC) diagnoses between 01/01/2014-31/12/2018 (inclusion period) and who were newly diagnosed with metastases within 365 days from a PC diagnosis in the inclusion period (index date). Evidence of surgical or medical castration at baseline was required and patients were included if they had evidence of resistance to castration. Patients were dropped if they had prescriptions of mCRPC-specific medication at baseline. Regimen analyses for first line therapy were performed by index year and stratified by age group (<80 vs ≥80). RESULTS: Among 185 mCRPC patients, first-line regimens included primarily ADT agents (91.9%), abiraterone (35.1%), docetaxel (28.7%), and enzalutamide (4.3%). The percentage of regimens containing docetaxel peaked in 2015 (39.4%) and dropped to 20.6% in 2018. In contrast, the percentage of regimens containing abiraterone was at its minimum in 2015 (21.2%) and rose to 50% in 2018 (60% among patients over 80). After enzalutamide approval in 2014, a quick uptake was observed among patients over 80 (14.3% of those diagnosed in 2017). The percentage of patients receiving ADT monotherapy decreased from 37.5% in 2014, to 29.4% in 2018, while the combination with abiraterone increased from 30.0% to 44.1%. Docetaxel in combination with ADT was prescribed for 25.0% of patients in 2014 and 14.7% in 2018. Enzalutamide was equally likely to be prescribed alone or in combination with ADT in 2015 (3.0%) and 2018 (2.9%). CONCLUSIONS: The results help understand recent shifts in management of mCRPC from cytotoxic chemotherapy to new agents such as abiraterone and enzalutamide, particularly among older patients.