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Abstract Introduction Prostate cancer follows a natural trajectory characterized by genetic alterations that transform initially hormone-sensitive cancer cells into castration-resistant prostate cancer (CRPC), which is associated with high mortality. This study endeavours to elucidate the predictive role of androgen receptor splice variant 7 (AR-V7) protein expression in determining the time to CRPC onset and overall survival in prostate cancer patients. Methods This retrospective cohort study utilized paraffin-embedded tissue block samples collected from prostate cancer patients undergoing Androgen Deprivation Therapy at Dr. Sardjito General Hospital between 2016 and 2022 (n = 47). AR-V7 protein expression was assessed via immunohistochemistry. Time to CRPC and overall survival were subjected to Log- Rank analysis and Cox regression. Results Patients exhibiting AR-V7 + protein expression experienced a considerably shorter time to CRPC onset compared to those with AR-V7-expression (21.13 vs. 40.05 months; p-value = 0.020). In the assessment of overall survival, patients with AR-V7 + protein expression demonstrated significantly poorer overall survival rates in contrast to those with AR-V7-expression (17.00 vs. 22.00 months; p = 0.00). Conclusions Diminished AR-V7 + protein expression emerges as a predictive indicator for a shortened time to CRPC onset. Moreover, AR-V7 protein expression holds prognostic value in predicting overall survival among prostate cancer patients.