To investigate the feasibility and effectiveness of the mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies in the diagnosis of prostate carcinoma.

A prospective and randomized study of 111 patients who underwent prostate biopsy for the first time in Yangjiang People's Hospital from March 2020 to March 2022 randomly assigned into two groups, with 56 cases in observation group and 55 cases in control group. The observation group adopted mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies, whereas the control group performed 12-needle systematic biopsies. The differences of overall puncture positive rate, the detection rate of clinically significant prostate cancer, the rate of missed diagnosis, the positive rate of single core, the tumor tissue length of specimen, the tumor proportion of specimen, postoperative complications and the cases of pathological upgrading after secondary puncture, transurethral enucleation or radical resection were compared between the two groups.

There were no significant differences in age, the positive rate of digital rectal examination,prostate volume, prostate-specific antigen (PSA), the cores of biopsies, PI-RADS scores and postoperative complications between the two groups. However, in the observation group, the overall puncture positive rate (50.0% vs 27.3%, P=0.014), the detection rate of clinically significant prostate cancer (50.0% vs 25.5%, P=0.008) and the positive rate of single core (26.8% vs 16.0%, P<0.001) was significantly higher than the control group. Moreover, the observation group showed longer tumor tissue length of specimen [(8±4) mm vs (4±3) mm, P=0.001], higher tumor proportion of specimen [(64.5±20.7)% vs (40.0±23.8)%, P=0.002], lower missed diagnosis rate (0% vs 25.0%, P=0.021), and less pathological upgrading cases after secondary puncture, transurethral enucleation or radical resection (0 vs 8, P=0.009).

The mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies can significantly improve the overall puncture positive rate and the detection rate of clinically significant prostate cancer, reduce the rate of missed diagnosis and the cases of pathological upgrading after secondary puncture, enucleation or radical resection, while the operation is simple, convenient, safe and suitable for clinical promotion.