Abstract: Objective: To investigate the value of transrectal ultrasonography(CETRUS) to assess the efficacy of neoadjuvant endocrine therapy(NHT) for high-grade prostate cancer(HGPCa) and to guide prognostic interventions. Methods: Ninety-eight patients with HGPCa in the Third Hospital of Mianyang of Sichuan from March2019 to March 2021, all of whom underwent NHT, were selected and the efficacy of NHT was counted. According to the efficacy of NHT, the patients were divided into good efficacy group and poor efficacy group, and the clinical data, CETRUS parameters peak intensity(PI), mean passage time(MTT), area under the curve(AUC),intensity halving time(HT), wedge inclination slope(WIS) and serum prostate-specific antigen(PSA) level were compared between the two groups. The correlation between CETRUS parameters and serum PSA level in HGPCa patients was analyzed, and the value of CETRUS parameters and serum PSA level in assessing the efficacy of NHT in HGPCa patients was analyzed by the receiver operating characteristic(ROC) curve. All patients underwent laparoscopic radical prostatectomy after NHT and were followed up for 1 year after surgery, and the followup was counted. Results: The rate of good efficacy of NHT in HGPCa patients was 52.04%(51/98); PI, MTT,AUC, HT, WIS and serum PSA level after NHT in the poor efficacy group were higher than those in the good effi-cacy group(P＜0.05); PI, MTT, AUC, HT and WIS were positively correlated with serum PSA level in HGPCa patients after NHT(P＜0.05); the AUCs of PI, MTT, AUC, HT, and WIS after NHT to assess poor efficacy were 0.760, 0.793, 0.778, 0.830, and 0.814, respectively, and all of them were close to the AUC of serum PSA to assess poor efficacy; the biochemical recurrence detection rate of CETRUS in HGPCa patients was 86.96%(20/23). Conclusion: CETRUS parameters are efficacious in assessing the efficacy of NHT in patients with HGPCa and can detect biochemical recurrence,which can help guide clinical interventions for prognosis.