Prostate cancer (PC) is the most common malignancy among men and is the fifth leading cause of cancer-related death in men worldwide. The present study aims to systematically review the ability of magnetic resonance spectroscopy (MRS) to differentiate between benign and malignant prostate lesions. According to the 06-PRISMA guideline, we searched in five English databases, including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar without time limitation for publications related to the role of magnetic resonance spectroscopy for prostate cancer diagnosis. The searched words and terms were: “prostate cancer”, “prostatitis”, “magnetic resonance spectroscopy”, “benign prostate hyperplasia”, “malignant prostate hyperplasia”, “comparison”. Totally 1927 papers were identified by database searching. Out of these papers, 261 papers were discarded because of duplication. Of the remaining 1666 papers, 1604 papers were discarded because of the inadequate information and the ones in which the abstract was submitted in congresses as preceding papers, conferences, and editorials without full text. Out of the remaining 62 papers which were studied for eligibility, 52 papers were removed for a number of reasons including inconsistency between methods with results, incorrect interpretation of the results, poor methodology, etc. Finally, 10 papers were included in this present study. In general, based on the results of the review of articles, MRS has optimal sensitivity, specificity and accuracy in diagnosing prostate cancer and differentiating it from benign prostate hyperplasia in comparison with other diagnostic and pathological methods. Due to the small number of studies related to the sensitivity and specificity of MRS, further checking was not possible to confirm these results. Therefore, further studies in this regard are recommended.