Objective To study the application value of transrectal real-time tissue elastography (TRTE) and quantitative parameter peak strain index (PSI) in the diagnosis of prostate cancer (PCa).Methods The clinical dataes of 100 suspected PCa patients in our hospital were retrospectively analyzed,all patients received the transrectal ultrasonography (TRUS) and TRTE ultrasonography.The TRUS and TRTE imaging characteristics of patients were recorded.The accuracy of the two methods was compared,which accorded to the gold standard of puncture biopsy results.The PSI value was calculated and the accuracy of PSI in judging the nature of prostate lesions was analyzed.Results There were 84 cases of PCa of pathological biopsy and 16 cases of benign prostate lesions.There were good agreement between TRUS,TRTE and the pathological results (Kappa = 0.612,0.797;P = 0.000).There were no significant difference in sensitivity, specificity and accuracy between TRUS and TRTE in the diagnosis of PCa (P > 0.05).The TRTE manifestations of PCa lesions were locally blue or covered with blue,the AUC of PSI to judge the nature of prostate lesions was 0.854 (95%CL = 0.735-0.973,S.E. = 0.061,P = 0.000),the sensitivity was 0.813, specificity was 0.786, and the best truncation value was 11.75.The sensitivity of PSI in the diagnosis of PCa was significantly higher than that of TRUS.,the difference was statistically significant (P < 0.05).Conclusion The TRTE combined with PSI quantitative parameters can improve the accuracy of PCa diagnosis and help to improve the positive detection rate.