Background: Advanced hormonal therapies (abiraterone, enzalutamide, apalutamide) and docetaxel have demonstrated an overall survival benefit when added to androgen deprivation therapy (ADT) for metastatic castration-sensitive prostate cancer (mCSPC). There are no randomized controlled trials comparing these agents, resulting in heterogeneity in first-line therapy and sequencing of therapies. Methods: We surveyed practice patterns and underlying rationale behind first-line therapy selection for mCSPC among medical and urologic oncologists at a single center (academic and community-based practices). Responses were anonymous. We evaluated associations between responses using Friedman’s test with posthoc pair-wise comparison and Fisher exact test where appropriate. Results: From 6/2021-8/2021, we received 72/77 (94%) of distributed surveys. Of the 72 providers, 39 (31 med/onc, 8 uro/onc) reported treating mCSPC. For high-volume disease, most selected ADT plus docetaxel (41%) as first-line therapy. For low-volume disease, most selected ADT plus abiraterone (31%). There continues to be the use of bicalutamide in the treatment of low-volume mCSPC (18%). When asked to rank the most important factors when considering first-line therapy, clinical symptoms (skeletal event, bone pain, anorexia, weight loss, fatigue, visceral metastases) and disease volume were ranked higher than cost for both oncologists (p<0.01) and urologists (p = 0.03 for symptoms vs. cost and p<0.01 for disease volume vs. cost). When considering perceived barriers to selecting first-line therapy, 64% of providers identified out-of-pocket costs. Although uro/onc was less comfortable managing side effects of docetaxel compared to med/onc (0% vs. 100% comfortable, p<0.01), comfort levels with managing toxicities of hormonal therapies were comparable (100% vs. 97% comfortable, p=0.54). Conclusions: Given limitations of cross-trial comparison of efficacy from registration trials, the selection of front-line therapy for mCSPC often depends on shared decision-making. By this survey-based study, we observed docetaxel being favored for high-volume disease and abiraterone being favored for low-volume disease. Although cost did not factor into the selection of therapy, it was cited as the most common barrier faced by providers.