Abstract: Objective To contrast the diagnostic efficacies of perineal and transrectal approaches for combined prostate biopsies guided via magnetic resonance imaging (MRI) and ultrasound fusion imaging.Method A retrospective analysis of clinical data from 271 patients subjected to combined prostate biopsies guided by MRI and ultrasound fusion imaging at the first people’s hospital of Wuxue city and Wuhan Tongji Hospital from January 2022 to November 2023 was conducted.They were divided into two groups according to the puncture path, 132 cases were transrectal and 139 cases were perineal.The differences between the detection rates of prostate cancer (PCa) and clinical significant prostate cancer (csPCa) across different prostate imaging reporting and data system (PI-RADS) scores and lesion localizations within the two puncture paths were compared.Results The detection rates of PCa in the perineal and transrectal puncture groups (68.3% vs. 59.8%,P=0.145) and csPCa (64.7% vs. 55.3%,P=0.112) did not exhibit statistically significant differences.However,the perineal puncture group experienced fewer complications.For patients with a PI-RADS score of 4,both PCa (77.2% vs.56.1%,P=0.027) and csPCa (71.9% vs.48.8%,P=0.02) detection rates were higher via the perineal combined biopsy),compared to the transrectal path.Additionally,for apical (PCa：84.3% vs.48.7%，P=0.001；csPCa：81.8% vs.48.7%，P=0.004) and anterior (PCa：77.1% vs.46.5%，P=0.006；csPCa：68.6% vs.44.2%，P=0.031) prostate lesions,the detection rates via the perineal combined biopsy were considerably higher than those of the transrectal path.Conclusion For patients carrying a PI-RADS score of 4 or with prostate lesions situated at the apical or anterior section,the perineal approach for biopsy sampling emerges as the most appropriate method.

Key words: prostate cancer, complication, biopsy