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Efficacy of abiraterone combined with flutamide on patients with prostate cancer (PCa) and its effect on levels of miR-493-5p and miR-195-5p contained in serum were investigated. The medical records of 146 PCa patients admitted to Longhua Hospital Shanghai University of Traditional Chinese Medicine from January 2011 to December 2013 were selected. Eighty-four patients were treated with abiraterone combined with flutamide as a study group, 62 patients were treated with abiraterone alone as a control group. The curative effect, adverse reactions, quality of life and five-year overall survival (OS) of the two groups were compared. The serum prostate-specific antigen (PSA) level was measured by radioimmunoassay at 3 days (T1) before treatment, 1 month (T2), 2 months (T3), and 6 months (T4) after treatment, and the relative expression of miR-493-5p and miR-195-5p in serum were detected by qRT-PCR. The total effective rate of the study group was significantly higher than that of the control group (P0.05); there was no significant difference in the relative expression of miR-493-5p and miR-195-5p between the two groups at T1 (P>0.05). In conclusion, abiraterone combined with flutamide has better curative effect and lower incidence of adverse reactions in patients with metastatic castration-resistant PCa (CRPC) than abiraterone alone, and can increase the expression levels of miR-493-5p and miR-195-5p in patient serum.