Elevated PSA detected for over 8 years, diagnosed with prostate cancer for over 1 month. Medical history: male, 64 years old. The patient’s tPSA was found to be elevated, about 5 ng/ml, during a physical examination 8 years ago. He had nocturia three times a night, with no other significant discomfort, and did not seek treatment. He then regularly monitored his tPSA. In 2016, his tPSA was 7.63 ng/ml. He underwent a prostate biopsy at another hospital. Postoperative pathology showed small clusters of atypical glands, but he did not receive treatment. The patient continued to monitor his tPSA and was informed that it was gradually increasing (details unknown). In the past 2 years, the patient has experienced weak urination and nocturia about four times per night, without treatment. In March 2022, his tPSA was 10.57 ng/ml. The patient visited our outpatient clinic for a dynamic enhanced MRI of the prostate, which showed a mass-like lesion in the left lobe, transition zone, and peripheral zone of the prostate. The edge was blurred, T2WI showed low signal, DWI showed high signal, ADC value was reduced, and PI-RADS score was 5 points; DCE: PI-RADS score was +. It involved the periprostatic capsule and left neurovascular bundle but did not involve the seminal vesicles, bladder neck, rectum, or pelvic floor muscles. Considering the abnormal signal in the left lobe transition zone and peripheral zone of the prostate, the possibility of prostate cancer is high (Fig. 1). The patient’s tPSA was retested in May 2022 and was 13.44 ng/ml. Considering the gradual increase in tPSA, he underwent a prostate biopsy in June 2022. Pathology: (tenth needle of prostate biopsy) Prostate adenocarcinoma (Gleason score 4 + 3, WHO grading group 3); no cancer was seen elsewhere. Whole body bone imaging did not show clear bone metastasis. Considering locally advanced prostate cancer, he was admitted to our hospital for surgery.