[Transrectal cognitive fusion versus transperineal image-fusion prostate biopsy: A comparative study]

Objective To compare the detection rate and safety of transrectal cognitive fusion prostate biopsy and transperineal multiparametric MRI-transrectal ultrasound(mpMRI-TRUS) fusion-guided prostate biopsy. Methods The clinical data of 462 patients who underwent mpMRI at the Eastern Theater Command General Hospital from June 2021 to May 2025 were analyzed retrospectively. All patients had at least one suspicious lesion with a PI-RADS score ≥3 and subsequently underwent targeted prostate biopsy. The results of targeted biopsy combined with systematic biopsy were defined as the combined biopsy results. The PCa detection rate, clinically significant PCa（csPCa）detection rate and incidence of complications were compared between the two groups. Diagnostic performances of systematic, targeted and combined biopsies were also compared between the two approaches. Results In targeted biopsy, the transperineal group had significantly higher PCa and csPCa detection rates than those of the transrectal group（48.11% vs 38.19%, and 39.31% vs 29.17%, P < 0.05）. There was no significant difference between the two groups in PCa and csPCa detection rates for systematic or combined biopsy （P>0.05）. The incidence rate of postoperative complications in the transperineal group was significantly lower than that of the transrectal group（14.78% vs 23.61%, P<0.05）. The detection rate of combined approach was significantly higher than that in either systematic or targeted biopsy alone（P<0.05）.Conclusion Compared to the transrectal approach, transperineal mpMRI-TRUS image fusion-guided prostate biopsy demonstrates greater safety and higher accuracy in targeted biopsy. The combined biopsy strategy can effectively reduce the risk of missed diagnoses in patients with PCa.