Objective To explore the clinical value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in differential diagnosis of benign and malignant prostatic lesions. Methods The clinical data of 72 patients with prostate diseases who underwent prostate MRI and DCE-MRI scan were analyzed retrospectively. All patients underwent pathological biopsy at 3 months after MRI scan to evaluate the sensitivity, accuracy and specificity of DCE-MRI in the differential diagnosis of benign and malignant prostatic lesions. The DCE-MRI image features of patients with benign and malignant lesions confirmed by pathology were analyzed. DCE parameters [contrast agent volume transfer constant (Ktrans), contrast reflux rate constant (Kep), extracellular space fraction (Ve), peak time (Tmax), the maximum enhancement degree (SImax), the maximum enhancement ratio (Rmax)] were compared. Results 45 cases of benign prostatic hyperplasia (BPH) and 27 cases of prostate cancer (PCa) were diagnosed by pathological biopsy. The sensitivity, specificity and accuracy of DCE-MRI in the differential diagnosis of benign and malignant prostatic lesions were 88.89%, 86.67% and 87.50% respectively. The Ktrans, Kep, SImax and Rmax were higher in patients with PCa than in patients with BPH, while Tmax was lower than in patients with BPH (P<0.05). However, there was no significant difference in Ve between the two groups (P>0.05). Conclusion There are obvious differences of DCE-MRI scan images and common parameters between patients with BPH and patients with PCa, and the accuracy of DCE-MRI in the diagnosis of benign and malignant prostatic lesions is relatively higher.