OBJECTIVES: The study assessed therapeutic management of patients with mPC, regarding pharmaceuticals and surgical interventions, and estimating healthcare costs of the different pathways. METHODS: An observational retrospective analysis, using administrative and pathological anatomy databases of 3 Local Health Units (LHUs) in Italy, was performed. Patients diagnosed with PC through histo-pathological records between January 1^st, 2009 and December 31^st, 2013 were included. The date of diagnosis of metastasis was used as the Index Date (ID). All patients with a new diagnosis of metastasis while on treatment with ADT were considered mPC and evaluated in the period from January 1st, 2009 (characterization period) to ID, and followed up till June 30th, 2014 (observation period). RESULTS: According to preliminary results on 259 patients with mPC, 148 (57.1%) were already undergoing androgen deprivation therapy (ADT) at ID and 111 (42.9%) were not. Focusing on mPC patients, 44% continued with the hormonal therapy, 19% had chemotherapy as first treatment, 11% had radiotherapy and 26% had a “watch and wait” approach with no disease related consumption. Mean age was 75 years for the first three groups and 82 years for the last. Average duration of follow-up was 17 months in ADT patients, 19 for chemotherapy, 13 for radiotherapy and 4 for the “Watch and wait.” Death rates were 65%, 62%, 65% and 97%, respectively. Per patient disease cost, during follow up, was around 6’500€ for mPC treated with ADT, 13’500€ for chemotherapy patients (2’600€ estimated for side-effects) and 7’600€ for radiotherapy subjects. CONCLUSIONS: The majority of PC patients were on ADT treatment at diagnosis of metastasis, and most continued with the therapy; the watch and wait approach appeared to be utilized in elderly patients with a poor prognosis. Healthcare costs were higher in mPC treated with chemotherapy patients, due to the longer follow-up and side-effects management.