Prostate specific antigen (PSA) blood test represents the standard procedure in prostate cancer (CaP) diagnosis and follow-up. However, determination of PSA in the urine, where PSA is present in much higher concentrations than in the blood, still remains in the field of research. Objectives: To determine urinary concentrations of PSA (uPSA) in different groups of patients (pts.), and to estimate is it possible to differentiate benign and malignant prostate diseases and to follow-up the results of treatment. Methods: Between January 2001. and November 2003., urinary concentrations of PSA were determined at 142 pts. divided in seven groups: 1. young and healthy volunteers, 2. "BPH-24": pts. with benign prostatic hyperplasia (BPH) who collected the sample of 24- hour voided urine, 3. "BPH-I": pts. with BPH who collected the first portion of first urinary voiding, 4. "TRUS-CaP": pts. with CaP which gave the first portion of urine just prior to transrectal ultrasound guided prostate biopsy (TRUS- biopsy), 5. "TRUSnon- CaP": pts. who gave first portion of urine prior to TRUS-biopsy, but biopsy did not prove the presence of CaP, 6. "RRP": pts. who underwent radical retropubic prostatectomy (RRP), 7. "AAT": pts. who underwent androgen deprivation therapy. Results: Average uPSA value in the group of young and healthy volunteers, was 13.8+19.6 ng/ml, in "BPH-24": 38.0+ 44.4 ng/ml, in "BPH-I": 140.8+140.9 ng/ml, in "TRUSCaP": 234.8+277.7 ng/ml, in TRUS-non-CaP: 113.1 +148.5 ng/ml, and in the group "RRP": 4.4+4.7 ng/ml. There was no statistically significant difference of average uPSA values between "BPH-I" and "TRUSCaP" groups. The significant difference was found between the group of young volunteers and "BPH-I". In "TRUS-CaP" group, there was strong correlation between tumor size and aggressiveness and uPSA concentration. Finally, PSA and uPSA decline during androgen deprivation therapy, strongly correlated (up to r=0.95). Conclusions: Determination of uPSA cannot differentiate BPH and CaP. However, in the group of pts. with proven localized CaP, uPSA can provide additional information concerning T-staging. Moreover, simultaneous monitoring of PSA and uPSA response on hormonal therapy, can provide an early recognition of androgen-in different CaP (AIPCA) and hormone resistant CaP (HRPCA).