Novel therapeutic regimes, functional imaging, next-generation sequencing, and better utilization of current treatment options in early-stage disease have changed the therapeutic landscape of metastatic prostate cancer (mPCa). For decades, the cornerstone of treatment for metastatic hormone-sensitive prostate cancer (mHSPC) has been androgen deprivation therapy (ADT). In recent years, docetaxel, abiraterone, enzalutamide, and apalutamide have shown to improve the overall survival (OS) for men with mHSPC when combined with ADT, raising the question of which treatment to choose. The role of radiation therapy to the primary tumor for selected low-volume patients in improving survival has also been proven. However, after the initial response, nearly all patients progress to castration-resistant prostate cancer (CRPC). Before 2010, docetaxel was the only life-prolonging agent for metastatic CRPC (mCRPC). The development of CRPC therapies has made significant progress over the last decade. Abiraterone, enzalutamide, apalutamide, darolutamide, Sipuleucel-T, radium-223, and cabazitaxel have been evaluated as first- and second-line therapeutic options in mCRPC patients. This chapter aims to discuss the survival benefits of different treatment regimens, including novel agents, in patients with mHSPC and mCRPC.