The management of metastatic castration-resistant prostate cancer (mCRPC) has seen significant advancements in recent years, driven by a better understanding of the genomic landscape and biology of this disease. Despite these advances, mCRPC remains incurable, and treatment focuses on improving survival while preserving patients' quality of life (QoL) and managing symptoms. Docetaxel is the standard first-line chemotherapy, while novel androgen receptor (AR) inhibitors like abiraterone and enzalutamide are used as second-line options. Genetic testing for mutations in DNA repair genes is recommended to guide treatment decisions. PARP inhibitors have shown promise in treating HRR-deficient mCRPC, with olaparib and abiraterone combination therapy improving outcomes in clinical trials. Immunotherapy has shown limited efficacy in unselected mCRPC populations, and theranostics, such as lutetium-177, offer a promising approach by delivering targeted radiation therapy. The future of mCRPC treatment lies in integrating these new therapies with precision oncology to optimize patient outcomes.The management of metastatic castration-resistant prostate cancer (mCRPC) has seen significant advancements in recent years, driven by a better understanding of the genomic landscape and biology of this disease. Despite these advances, mCRPC remains incurable, and treatment focuses on improving survival while preserving patients' quality of life (QoL) and managing symptoms. Docetaxel is the standard first-line chemotherapy, while novel androgen receptor (AR) inhibitors like abiraterone and enzalutamide are used as second-line options. Genetic testing for mutations in DNA repair genes is recommended to guide treatment decisions. PARP inhibitors have shown promise in treating HRR-deficient mCRPC, with olaparib and abiraterone combination therapy improving outcomes in clinical trials. Immunotherapy has shown limited efficacy in unselected mCRPC populations, and theranostics, such as lutetium-177, offer a promising approach by delivering targeted radiation therapy. The future of mCRPC treatment lies in integrating these new therapies with precision oncology to optimize patient outcomes.