The authors used two monthly curated databases of patients with castration–resistant prostate cancer (CRPC) to describe the natural history of patients dying of CaP in the modern era. In the modern era, approximately half of the patients who die from CaP have metastases at diagnosis.

The paradigm of progression from localized disease to metastasis and eventually death is only represented in the other half, although possible initial screening and staging errors ought to be taken into consideration. More efforts are needed to conduct trials in patients with newly diagnosed metastatic CaP.

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