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INTRODUCTION AND OBJECTIVES: In advanced prostate cancer, competing therapies often offer prolongation of life or improvement in quality of life but not both. Previous studies have reported that patients with advanced cancer are not distressed by prognostic and treatment information. 2 These observations suggest that discussion of the expected benefits of each treatment option can facilitate shared decision-making allowing for incorporation of patient preferences and values into the treatment plan. We sought to understand how metastatic castrate-resistant prostate cancer (mCRPC) patients and their physicians discuss treatment goals. METHODS: This institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant, observational, linguistic study analyzed conversations between mCRPC patients and their oncologist or urologist during a naturally-occurring clinic visit in 2011. The videotaped clinic visits had no 3rd-party observers present and both participants were interviewed separately after the visit using standardized questionnaires. All conversations were analyzed with standard anthropology and discourse analysis techniques. RESULTS: We observed a number of information gaps during 42 clinic visits involving mCRPC patients (69% African-American) and their physician (7 urologists; 7 oncologists). In particular, explicit conversation about the patients’ goals for therapy or the terminal nature of the disease did not occur in any physician-patient discussion. In postvisit interviews, physicians primarily viewed the care plan as preserving quality of life while patients tended to believe their care plan focused on extending life. Both patients and physicians assumed that their views on treatment goals were aligned with each other. The absence of direct dialogue allowed this gap to persist. CONCLUSIONS: Universally, the discussion of “quality” versus “quantity” of life is understood to be difficult. In this research, discussions about setting or revisiting treatment goals was notably absent from the patient-physician dialogue. This research highlights a need to enhance communication between patients and providers that facilitate alignment of treatment goals and expectations in mCRPC patients. Fowler FJ et al. JAMA 2000;283(24):3217-3222 Smith TJ et al. J Supportive Onc 2011;9(2):79-86.