Abstract: Prostate lesions are common in middle-aged and elderly men. Dual-energy CT (DECT) can capture projection data at high and low X-ray energies in a single scan, significantly enhancing its ability to differentiate substances compared with traditional CT. DECT not only provides routine anatomical information of lesions, tissues, and organs, but also generates virtual single-energy spectral images, virtual decalcification images, effective atomic number diagrams, iodine maps, electron cloud density maps, and other energy spectral images through post-processing. Additionally, DECT derives relevant quantitative parameters such as iodine concentration, standardized iodine concentration, and slope of the energy spectrum decay curve, aiding in the functional evaluation of diseased tissues. This capability is crucial for the early detection and qualitative and quantitative evaluation of prostate lesions. Numerous studies have shown that DECT has great potential for the differential diagnosis of prostate lesions, preoperative staging, and proton therapy. This article reviews the research and application advancements of DECT in prostate lesions and explores future research directions.