Objective To investigate the economic burden, psychological distress and quality of life in elderly patients undergoing radical resection of prostate cancer (PCa) and to analyze their correlation. Methods A total of 118 elderly PCa patients were included as the study subjects, who underwent radical resection in the First Affiliated Hospital of Xinjiang Medical University from February 2020 to August 2022 and paid a follow-up visit at 3 months after surgery according to the doctor′s advice. A questionnaire survey was conducted to statistically analyze the economic burden of disease, psychological distress, and quality of life. SPSS 19.0 was used for statistical analysis. Data comparison between two groups was preformed using t test orχ² test, depending on data type. Pearson correlation analysis was used to analyze the relationship between economic burden, psychological pain, and quality of life. Multiple linear regression models were used to analyze the factors affecting the quality of life of the elderly PCa patients. Results Totally, 118 questionnaires were distributed and 108 were collected (91.53%). The total score of functional assessment of cancer therapy-prostate (FACT-P) quality of life scale was found to be (101.41±16.27) points, the average score of comprehensive scores for financial toxicity based on the patient-reported outcome measures (COST-PROM) scale to be (24.25±6.14) points, and the average score of distress thermometer (DT) to be (3.43±0.53)points, and the patients with DT≥4 points accounted for 41.67% (45/108). Pearson correlation analysis showed that quality of life in the elderly PCa patients was negatively correlated with DT (r=-0.346; P<0.05) and was positively correlated with score of COST-PROM scale (r=0.433; P<0.001). Multivariate linear regression showed that urinary tract compression symptoms (β=0.296; P<0.001), psychological distress (β=0.296; P<0.001) and economic burden (β=-0.342; P<0.001) were factors affecting the quality of life in the elderly patients undergoing radical resection of PCa. Conclusion The quality of life in the elderly patients after radical resection of PCa is not high with different degrees of psychological distress, and the overall economic burden is at a moderate level. Adjusting the psychological distress and economic burden of patients can enhance the postoperative quality of life to some extent.