This study set out to investigate whether patients in rural areas tend to have more advanced prostate cancer (PCa) than urban areas in Hunan province, define possible factors related to the stage at diagnosis of PCa between rural and urban areas, and to determine the potential correlations between these factors and PCa stage at time of diagnosis. Data were used from a retrospective database of 490 PCa patients from the Third XiangYa hospital. Rural and urban differences in PCa stage, age, delay in diagnosis, prostate specific antigen (PSA) values, PSA screening, and metabolic syndrome were described and analyzed. Pearson correlation, Spearman correlation, and multiple linear regression were performed to examine the correlations between factors which may attribute to regional differences and stage. The percentage of advanced stage in rural cases was higher than in urban cases. Moreover, younger age, longer delay in diagnosis, less metabolic syndrome, and fewer PSA screening prior to diagnosis were observed in rural patients compared with the urban patients. Current study revealed that rural patients were more likely to have advanced PCa stage and PSA values at time of diagnosis. Perhaps, most importantly, these data