Abstract: Objective: To investigate the predictive value of serum CXC chemokine ligand 4L1(CXCL4L1) and prostate specific antigen(PSA) combined with ultrasonic parameters for Gleason grade after prostate cancer surgery. Methods: A total of 100 patients with prostate cancer who underwent transurethral resection of prostate in Xinyu People's Hospital of Jiangxi Province from June 2021 to December 2022 were selected as the research subjects and divided into low-medium risk group(Gleason score≤7, 70 cases) and high-risk group(Gleason score≥8, 30 cases) according to postoperative Gleason grade. The levels of serum CXCL4L1, total prostate specific antigen(tPSA), free prostate specific antigen(fPSA), and ultrasound parameters prostate specific antigen density(PSAD), prostate internal gland specific antigen density(IGPSAD), prostate external gland specific antigen density(EGPSAD), ultrasound score were compared between the two groups. The predictive value of serum CXCL4L1, fPSA, tPSA, and ultrasound parameters for postoperative Gleason grade was evaluated. Results: The serum levels of CXCL4L1, fPSA, and tPSA in the high-risk group were higher than those in the low-medium risk group, while PSAD, IGPSAD, EGPSAD, and ultrasound scores were higher than those in the low-medium risk group(P＜0.05); the AUC predicted by the combination of serum CXCL4L1, fPSA, t PSA, and ultrasound parameters for postoperative Gleason grade was greater than that predicted by each indicator alone(P＜0.05). Conclusion: Serum CXCL4L1, PSA and ultrasound parameters are closely related to the Gleason grade and clinicopatho-logical features after prostate cancer surgery. The combined detection of CXCl4L1 and PSA levels has certain value in predicting the Gleason grade after prostate cancer surgery.