Bone targeted therapy with zoledronic acid or denosumab has been shown to reduce the rates of skeletal-related events when initiated at the time of castrate resistance for prostate cancer. However, when studied in the hormone-sensitive setting there was no benefit to early initiation of zoledronic acid. In the current era of effective, life-prolonging therapies in castrate-resistant prostate cancer (CRPC) the benefit of early initiation of bone-targeted therapies with associated toxicities is unclear.