BACKGROUND The objective of this study is to evaluate the relationship between PSA value and prognosis of the patients with stage D2 prostate carcinoma. METHODS Serum prostate specific antigen was analyzed in 61 patients with stage D2 prostate carcinoma submitted to hormone therapy. RESULTS The median values of PSA parameters were 77.6 ng/ml for the initial PSA, 91.8% for the maximal decrease, 2.7 ng/ml for the nadir, 1.1 months for the half-time time, 3.0 months for the time to nadir, 3.2 months for the doubling time after progression and 0.39 for the ratio of antemortem versus initial PSA. The median biochemical progression-free time was 15.0 months and the median actuarial survival after progression was 24.9 months. The progression-free time was significantly correlated with the normalization of PSA (p < 0.001) and the initial PSA of less than 100 ng/ml (p < 0.05), and the survival time after progression was significantly correlated with the doubling time (p < 0.05). The normalization of PSA was affected by initial value, maximal decrease rate and half-life time of PSA respectively, but not by the histological grade of the primary tumors. The doubling time was not correlated with these factors nor with the progression-free time. CONCLUSIONS The results show that the initial value, nadir level and doubling time of PSA can be used as prognostic parameters for prostatic carcinoma. Both the low ratio of premortem versus initial PSA, which may reflect an increase of stem cell fraction, and the PSA doubling time after relapse, which seems similar to or shorter than that of untreated cases, will indicate an aggressive potential of hormone-refractory tumors.