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Objective To investigate the predictive value of preoperative neutrophil to lymphocyte ratio (NLR), interleukin-35 (IL-35) and metastasis-associated protein 2 (MTA2) for postoperative recurrence and metastasis in patients with prostate cancer. Methods A total of 160 elderly patients who received prostate cancer surgery in the Second Affiliated Hospital of Hebei North University from June 2019 to June 2022 were selected as the study subjects and divided into the occurrence group (68 cases) and the non-occurrence group (92 cases) according to the presence or absence of postoperative recurrence or metastasis. The general data of the two groups were compared, and the correlation between NLR, IL-35 and MTA2 and the risk of postoperative recurrence and metastasis in patients with prostate cancer was analyzed by logistic regression. ROC curve was used to assess the predictive value of each index for the risk of postoperative recurrence and metastasis in patients with prostate cancer. Results There were significant differences in TNM grade, Gleason score, NLR, IL-35 and MTA2 between the two groups (P < 0.05) . Logistic regression analysis showed that NLR, IL-35 levels and MTA2 scores were independent risk factors for postoperative recurrence and metastasis in prostate cancer patients after adjusting for multiple confounders (P < 0.05) . ROC curve showed that NLR, IL-35 levels and MTA2 scores had some predictive value for postoperative recurrence and metastasis in prostate cancer patients. Conclusion NLR, IL-35 levels, and MTA2 scores will have predictive value for the recurrence and metastasis of prostate cancer after surgery. They will play an important role in the early identification of high-risk patients for recurrence and metastasis after prostate cancer surgery and in improving patient prognosis.