Background: The development of mCRPC is generally observed in senior adults and in the daily clinical practice it is frequent to treat pts ≥ 80 yrs. In this population comorbidities can influence the treatment choices and, consequently, the clinical outcomes. The aim of this retrospective study was to describe management and clinical outcomes in mCRPC pts ≥ 80 yrs treated in the daily clinical practice. Methods: We retrospectively evaluated all mCRPC pts treated in our Institution from 02/2002 to 06/2015 and recorded their medical history, anticancer treatments and survival outcomes. Results: We evaluated a consecutive series of 45 pts aged ≥ 80 yrs: median age was 83 yrs (range 81-90 yrs). At the time of mCRPC development bone, nodal, and lung mets were present in 84%, 60%, and 9% of the cases, respectively; no pts with liver mets were observed. Pain was present 53.3% of the pts, the ECOG PS 2 rate was 17.1%. These baseline characteristics were not statistically different compared to those of the younger counterpart. Most of the elderly pts received docetaxel (78%), although this rate was significantly higher (96%) in the younger population (p < 0.0001); similarly elderly pts received less frequently cabazitaxel (CAB) (2% vs 16%, p = 0.01). On the contrary elderly population received more frequently only new generation hormonal agents [abiraterone (AA) or enzalutamide ENZ)] without any chemotherapy (22% vs 4%, p < 0.0001). The median cumulative overall survival (OS) from the start of the first treatment line for mCRPC was 20.5 mos (compared to 21.1 of younger pts). In the elderly population a significant different median OS was observed by comparing pts who received the new agents [NAs (AA, CAB, ENZ, Radium 223)] e those who did not (22.9 vs 13.0 mos, p = 0.001). Conclusions: Although the limitation due to its retrospective nature, our analysis showed that mCRPC pts ≥ 80 yrs were managed differently than younger ones. Nevertheless, the survival outcomes did not differ from the younger counterpart and also very elderly pts benefitted from the introduction of NAs in the daily clinical practice.