Objective: To explore the diagnostic value of shear wave elastography (SWE) and multi-parameters magnetic resonance imaging (mpMRI) in clinically significant prostate cancer (csPCa). Methods: From October 2020 to January 2022, patients suspected of prostate cancer (PCa) and underwent ultrasound-guided prostate biopsy were selected retrospectively for the study in the Department of Urology of the affiliated Hospital of Yan'an University. A total of 74 patients were enrolled. According to the pathological results of puncture biopsy, the patients were divided into PCa group and non-PCa group, csPCa group and non-PCa+ clinically insignificant adenocarcinoma group (cisPCa), including PCa group (n = 24) and csPCa group (n = 17). Univariate and multivariate logistic stepwise regression analysis was used to screen independent predictive factors of csPCa, and the diagnostic efficiency of the predictive probability value and each independent predictive factor were compared by ROC. Results: There were statistically significant differences between the PCa group and non-PCa group, csPCa group and non-PCa+ cisPCa group in tPSA, fPSA, PV, PSAD, PIRADS, Emax difference, Emean difference and Emin difference. Logistic regression results showed that tPSA, PV, Emax difference and PIRADS were independent predictive factors for csPCa. ROC results showed that the area under curve (AUC) of logistic regression model was 0.954, sensitivity was 0.882, specificity was 0.947, which were better than each independent predictive factor. Conclusion: Emax difference and PIRADS are independent predictive factors of csPCa, and combined with tPSA and PV has great diagnostic performance.