Background/Aim: Prostate cancer (PCa) is the most frequent cancer found in males worldwide, and its mortality rate is increasing every year. However, there are no known molecular markers for advanced or aggressive PCa, and there is an urgent clinical need for biomarkers that can be used for prognosis and prediction of PCa. Materials and Methods: Mass spectrometry-based proteomics was used to identify new biomarkers in tissues obtained from patients with PCa who were diagnosed with T2, T3, or metastatic PCa in regional lymph nodes. Results: Among 1,904 proteins identified in the prostate tissues, 344 differentially expressed proteins were defined, of which 124 were up-regulated and 216 were down-regulated. Subsequently, based on the results of partial least squares discriminant analysis and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses, we proposed that spermidine synthase (SRM), nucleolar and coiled-body phosphoprotein 1 (NOLC1), and prostacyclin synthase (PTGIS) represent new protein biomarkers for diagnosis of advanced PCa. These proteomics results were verified by immunoblot assays in metastatic PCa cell lines and by indirect enzyme-linked immunosorbent assay in prostate specimens. Conclusion: SRM was significantly increased depending on the cancer stage, confirming the possibility of using SRM as a biomarker for prognosis and prediction of advanced PCa. According to a recent report from the American Cancer Society, prostate cancer (PCa) has the highest incidence of any cancer, and the mortality arising from PCa is second among all male cancers in the USA (1). Although most PCa is found at a local or regional stage, with a 5-year survival rate of close to 100%, the 5-year survival rate for those with late-stage PCa drops sharply to 30% (2, 3). Advanced PCa, also called metastatic PCa, is an aggressive form that causes the prostatic adenocarcinoma to spread to other parts of the body, including pericapsular tissues, with lymph-node involvement, and distant metastases, which is histologically defined as stages T3 and T4 (4, 5). Overall, PCa has one of the highest incidence and mortality rates among cancers, and most of the deaths due to PCa are a result of metastasis. Thus, finding a biomarker for advanced PCa associated with metastasis and aggression is a pressing need in clinical research aimed at treating PCa. Tissue, blood, urine, and seminal fluids derived from patients are the typical sources used for the study of PCa biomarkers. Such bio-fluid samples are safe, owing to the noninvasive collection methods used, and can be collected quickly, lowering the cost of sample preparation. However, it is difficult to find low-abundance biomarkers in these samples, since most of the protein in the blood and urine is either albumin or uromodulin, respectively. In contrast, tissues collected after surgery can be used to directly observe the 195 This article is freely accessible online.