Background: The purpose of this study was to analyze prognostic factors to predict overall survival in patients with castration-refractory prostate cancer (CRPC). Methods: A total of 68 patients with CRPC treated by secondary hormonal therapy (dexamethasone) and/or chemotherapy including docetaxel were analyzed. Primary endpoint was survival after PSA relapse. PSA relapse was defined as 3 consecutive PSA increase and serum PSA more than 4 ng/ml. Factors analyzed to predict survival were initial PSA value, initial clinical stage, pathological tumor grade (WHO grade), time to PSA relapse, nadir PSA value, time to nadir PSA, age at PSA relapse, PSA value at relapse, radiographic progression revealed by bone scan or CT scan, and bone pain. Univariate and multivariate analysis were performed using Cox regression hazard model. Results: Univariate analysis revealed nadir PSA value, time to nadir PSA, PSA value at relapse, radiographic progression revealed by bone scan or CT scan, and bone pain were significant predictors (p<0.05). Multivariate analysis revealed only radiographic progression was the independent predictor for survival after PSA relapse (p=0.039). Median survival time was 63.5 and 23.5 months in patients with (n=39) and without (n=29) radiographic progression, respectively (log-rank p=0.0002). Median survival time in 39 patients with radiographic progression in bone (n=31), lymph nodes (n=6), visceral lesion (n=3), and local lesion (n=4) were 23.5, 5, 2, and 12.5 months, respectively. Conclusions: For patients with PSA relapse after hormonal therapy, the finding of radiographic progression was the only independent factor to predict overall survival.