OBJECTIVES:  The management of metastatic castration-resistant prostate cancer (mCRPC) has evolved considerably with the inclusion of docetaxel-based chemotherapy, bone-targeted therapies and more recently abiraterone for docetaxel-refractory patients. Our study aimed to analyze contemporary mCRPC management patterns and therapy utilization trends in Quebec, Canada. METHODS:  The cohort included patients dying of prostate cancer (PCa) between January 2001 and December 2013 and selected from the public healthcare insurance databases, the Régie de l’Assurance Maladie du Québec (RAMQ) and Med-Echo databases. Patient selection was based on PCa-related death and/or therapy utilization according to the Canadian Urological Association guidelines. Multivariate logistic regression was used to identify factors associated with the probability of receiving chemotherapy, bone-targeted therapies and palliative radiotherapy (RT) before death from PCa. RESULTS:  Overall 3,106 patients were identified in our cohort. The median age of death was 78 years old. Most (83%) received mCRPC-specific treatments: chemotherapy, abiraterone, palliative RT or bone-targeted therapy, while 17% of patients were managed only with maximum androgen blockade, despite diagnosis of PCa-related death. Logistic regression analyses indicate that patients dying after 2005 were more likely to have received chemotherapy (OR 1.51; 95%CI 1.22-1.85) and bone-targeted therapy (OR 1.97; 95%CI 1.64-2.37). Age was a significant predictor of utilization of chemotherapy, bone-targeted therapy and palliative RT (ORs ranged from 0.96 to 0.98, p < 0.05). CONCLUSIONS:  Patient age seems to be a strong determinant in mCRPC therapy selection, with an impact in the probability of chemotherapy, bone-targeted therapy or palliative RT utilization. While chemotherapy is still used only in a minority of patients, the introduction of new therapies such as bone-targeted therapy, docetaxel and abiraterone affected treatment selection over time.