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Background: The association of serum free testosterone (FT) with prostate cancer is not fully understood. Studies on the results of the relationship between serum testosterone level and prostate cancer are conflicting. However, there is a reported association between lower serum testosterone levels and high-grade prostate cancer., Objective: To investigate the relationship between serum FT and the clinico-pathological characteristics of prostate cancer in South African patients., Materials and Methods: The clinical data of 109 consecutive patients diagnosed with prostate cancer on biopsy were evaluated prospectively. The variables were age, ethnic group, prostate specific antigen (PSA), digital rectal examination (DRE) findings, clinical tumour, nodes and metastases (TNM) stage, and Gleason score. Low serum FT was defined as <250ng/dl. Statistical analysis was performed using Stata V10 software (p<0.05 considered significant)., Results: There was a statistically significant association between low serum FT and high serum PSA, high Gleason score and clinically advanced stage prostate cancer., Conclusions: In this cohort of men with histologically diagnosed prostate cancer, low serum FT was associated with higher PSA, higher grade, and locally advanced or metastatic prostate cancer.