Objective To study the value of magnetic resonance spectroscopic imaging (MRSI) with only surface coils in diagnosing prostate cancer. Methods A total of 48 elderly patients with surgery or biopsy-confirmed benign prostatic hyperplasia or prostate cancer were preoperatively examined by surface coils for three-dimensional simple multi-voxel magnetic resonance spectroscopy scans, and the voxel (choline[Cho]+creatine[Cr])/citrate(Cit) values were calculated. According to the pathological findings, the voxels were divided into prostate cancer and non-cancer. The voxel (Cho+Cr)/Cit values of prostate central zone and prostate peripheral zone were analyzed. The voxel nature of (Cho+Cr)/Cit value was used as the gold standard receiver to plot characteristic curve (ROC curve) and to calculate the area under the curve; the maximal Youden index was used as the standard to obtain the cut-off value and the corresponding sensitivity and specificity. Results The voxel (Cho+Cr)/Cit values of different natures were significantly different (P<0.001). When the area under the ROC curve of (Cho+Cr)/Cit value was used for diagnosis of prostate cancer, the central zone was 0.652, and the peripheral zone was 0.821. For the cut-off value, the central zone was (Cho+Cr)/Cit=0.645, with the corresponding sensitivity and specificity being 0.512 and 0.71, respectively; the peripheral zone was (Cho+Cr)/Cit=0.815, with the corresponding sensitivity and specificity being 0.72 and 0.84, respectively. Conclusion Surface coil alone can successfully complete the three-dimensional proton spectroscopic imaging of prostate, and (Cho+Cr)/Cit=0.815 for the cut-off value has a high diagnostic value for peripheral zone prostate cancer.