Prostate cancer is one of the most common malignancies among males worldwide. Accurate assessment of lymph node status and optimization of surgical scope are essential for improving patient outcomes. Traditional imaging technologies lack the sensitivity for real-time guidance and micrometastasis detection. Near infrared (NIR) fluorescence imaging provides advantages such as non-invasiveness, high sensitivity, deep tissue penetration, and real-time visualization, which can significantly enhance the efficiency of lymphatic tissue imaging and pathological diagnosis in prostate cancer. While non-specific dyes like indocyanine green (ICG) are widely used, but lack tumor specificity. NIR probes targeting prostate-specific membrane antigen (PSMA) can accurately detect cancerous lymph nodes and micrometastases, supporting surgical navigation and personalized therapy. This emerging approach that integrates targeted strategies with NIR-II imaging not only ensures specificity but also overcomes the limitations of NIR-I in tissue penetration depth and signal-to-noise ratio. When combined with artificial intelligence (AI)-assisted pathological analysis, these advances may enhance the detection of small metastatic lesions and facilitate precision medicine in prostate cancer.