OBJECTIVES: Castration resistant prostate cancer (CRPC), which occurs in 10-20% of patients with prostate cancer (PC), has had a historically poor prognosis. However, there are a number of emerging treatment options.  The aim of this study was to describe the real-world treatment patterns of CRPC in Japan. METHODS: A retrospective chart review of patients with mCRPC (N=445) was conducted from December 2014 to February 2015 with urologists (N=176) from online physician panels.  Charts from the most recent patient visits meeting the inclusion criteria were used.  Patient demographics, health history, healthcare resource use, treatment information, and clinical outcomes were entered into an online data collection form.  RESULTS: Patients (N=445) were an average of 73.57 years old (SD=8.34), had been diagnosed with PC for 5.12 years (SD=6.22), and had been castration resistant for 2.31 years (SD=1.98).  Androgen deprivation therapy was used among 43.64% of patients in 1^st line and 40.68% in 4^th line. Enzalutamide and abiraterone were also common, though more so in later lines because of their recent availability (used among 14.46% and 8.73%, respectively, of patients in 1^st line and 40.68% and 20.34%, respectively, in 4^thline).  NSAIDs and opioids were used frequently for pain management. The presence of symptomatic skeletal events (SSEs) was uncommon (2-3% within each treatment line) but associated with an increased use of opioids, strontium-89, bisphosphonates, and NSAIDs (all p<.05). Patients who experienced an SSE at any point (N=24) reported significantly more annualized post-SSE physician visits (Adjusted means=23.46 vs. 12.13) and general ward hospitalizations (Adjusted means=2.23 vs. 0.71) than those without an SSE (N=421; all p<.05).  CONCLUSIONS: Novel anti-hormone therapies are widely accepted in clinical practice, becoming more common than chemotherapy. The results also suggest that SSEs are associated with more medical resources and analgesics, highlighting the unmet medical needs for treatment of bone metastases.