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Prostate diseases, including prostate cancer and benign prostatic hyperplasia, have become significant threats to men's health. Accurate and reliable diagnostic methods are critical for early detection and timely intervention. Although current imaging modalities such as conventional transrectal ultrasound, computed tomography, and magnetic resonance imaging play a crucial role in the diagnosis and treatment monitoring of prostate diseases, they remain hampered by certain limitations that prevent them from comprehensively and precisely addressing clinical demands. Ultrasound elastography (UE), as a rapidly emerging medical imaging technology, is gradually demonstrating broad application prospects in the diagnosis and treatment monitoring of prostate diseases. Numerous studies have validated the efficacy of UE in the diagnosis of prostate diseases, demonstrating its significant advantages in diagnostic accuracy and reduced invasiveness compared with conventional methods. Nevertheless, challenges persist in translating UE into routine clinical practice, such as the lack of standardized protocols, variability in result interpretation, and limited equipment availability. This article reviews the role of UE in the diagnosis and treatment monitoring of prostate diseases, critically evaluates its clinical potential and challenges, and serves as a reference for future in-depth research and clinical applications.