Objective To evaluate the value of transrectal real time tissue elastography combined with peak strain index targeting needle biopsy in the diagnosis of peripheral zone prostate cancer.Methods A total of 127 patients with suspected peripheral prostate cancer were selected. All patients underwent transrectal ultrasound (TRUS) and transrectal real-time tissue elastography (TRTE) examination, and the peak strain index (PSI) was calculated based on the pathological results.The diagnostic results of TRUS system biopsy and TRTE combined with PSI-targeted biopsy in peripheral zone prostate (PCa) were compared, and ROC curve was drawn to analyze the diagnostic efficacy of TRTE combined with PSI-targeted biopsy in peripheral zone prostate (PCa).Results 92 PCa patients were detected with PSI averaging 26.91±14.66.The mean PSI was 7.49±6.35 in 35 benign lesions of prostate, and the difference was statistically significant (t=4.491, P < 0.001).The sensitivity and specificity of TRTE combined with PSI targeted biopsy in the diagnosis of PCa were 92.39% and 88.57%, both of which were higher than that of TRUS combined with systematic puncture biopsy.ROC curve analysis showed that the area under curve (AUC) of PCa diagnosed by TRTE combined with PSI-targeted biopsy was 0.923 with a cut-off value of 9.72 PSI [95% confidence interval: 0.879- 0.967], and when PSA>20 ng/ mL, the sensitivity and specificity of TRTE combined with PSI targeted biopsy for the diagnosis of peripheral zone PCa were 96.08% and 91.82%, respectively.Conclusion Real-time transrectal tissue elastography combined with peak strain index targeting biopsy of peripheral prostate cancer has good clinical application value.