With the wide application of transrectal prostate ultrasound technology in clinical practice, the initial finger-guided prostate biopsy has been eliminated, and TRUS-guided prostate aspiration biopsy has become the gold standard for prostate diagnosis.Hodge established the TRUS-guided systematic 6-point puncture technique in 1989 [4], and later scholars found that the false-negative rate of 6-point puncture method was higher, amounting to 20-3O%. In order to improve the detection rate of prostate cancer, different researchers suggested 8-point, l0-point, 12-point, 13-point and saturated puncture methods and found that more number of puncture needles can significantly improve the detection rate [4-7]. However, there are some findings that confirm that a small increase in the number of puncture needles does not significantly improve the positive detection rate of prostate cancer [8, 9]. The main reason for this controversy is that previous punctures were randomized, and the detection rate may not change significantly when the number of additional puncture needles is small. In our study, we found that the detection rate could be increased by 28.8% with the combination of imaging-based randomized puncture and directional puncture, even though the number of needles increased by only 3.5 needles, which was a significant advantage over the previous randomized puncture alone. Chen et al. demonstrated that more than 80% of prostate cancers were multifocally distributed and located in the peripheral zone, and small-sized cancer foci were concentrated in the apical region [10]. In prostate cancer patients with normal or mildly elevated PSA, most of the foci occurred in the apical region [11]. Vis et al. conducted an in vitro simulation of perineal and transrectal prostate aspiration biopsy on 40 radical prostatectomy specimens, and found that the positivity rate of the perineal route was higher than that of the transrectal route [12]. The leakage rate of transperineal puncture is lower mainly because the puncture needle passes longitudinally parallel to the rectum through the tip of the prostate, which can obtain more specimens of peripheral band of the prostate, and these sites are the most favorable sites for prostate cancer; when puncture is performed through the transrectal route, the puncture needle is crossed with the peripheral band, and most of the specimens obtained are the prostate tissues of the migratory zone hyperplasia, and the peripheral band of the prostate tissues can be easily missed. However, there is also literature that there is no difference in the detection rate between the two [13]. Therefore, it is more widely accepted that the number of puncture needles in prostate biopsy is more important than which puncture route is used [14]. The main reason for choosing the transperineal route of puncture in this study is that we have gradually mastered the technique of precise transperineal template prostate puncture through the use of this device, based on our previous experience of applying computerized treatment systems and ultrasound-guided transperineal template implantation of radioactive particles in the treatment of prostate cancer. Due to the use of the template, the accuracy of puncture is greatly improved by overcoming the disadvantage of the puncture needle being prone to deviation due to the long needle path. The puncture needle is inserted parallel to the ultrasound probe, which can effectively avoid damaging the rectum; moreover, the needle distance is controlled in the range of 0.5-1 cm, which is evenly distributed and theoretically reduces the possibility of leakage [15]. This study suggests that transperineal puncture also has the following advantages compared with transrectal prostate puncture biopsy: firstly, the disinfection of perineal skin is easier and more exact than rectal disinfection, so the possibility of infection in transperineal puncture biopsy is greatly reduced, and the use of oral antibiotics to prevent infection for 1 day before the operation, the risk of serious infectious complications in the postoperative period is extremely low [16]; secondly, due to the fewer complications, transperineal puncture can be more easily done by increasing the number of puncture needles, and the complication rate was not significantly higher in this study despite the increased number of puncture needles. The significance of transrectal diagnosis, transrectal ultrasound, MRI, PSA and related indexes in diagnosing prostate cancer has been reported in the literature, and the present study suggests that high-field-strength magnetic resonance has a higher detection rate of prostate cancer, and we analyzed the magnetic resonance images carefully before puncture to mark the suspected lesion area, and realized precise directional puncture under the guidance of real-time ultrasound to improve the positive rate of the puncture significantly.PSA is still the most important screening test for prostate cancer patients. PSA is still the main means of screening for prostate cancer patients, with a higher positive rate in patients with T-PSA ≥10ng/ml. For patients with T-PSA 4-10 ng/ml, the positive rate is higher in patients with F/TPSA <0.16< span=""> and PSAD ≥0.15. Therefore, the above indicators should be fully analyzed before the selection and implementation of puncture biopsy, which is especially important for patients with prostatic hyperplasia and PSA values in the gray zone. In recent years, with the continuous improvement of puncture-assisted imaging technology, many new and more accurate puncture modes have appeared, including magnetic resonance-guided prostate puncture biopsy, transrectal ultrasound and magnetic resonance fusion-image-guided prostate puncture biopsy, real-time ultrasound elastography-guided prostate puncture biopsy, and ultrasound tissue scanning (Histoscanning), all of which can significantly improve the detection rate of prostate cancer. detection rate of prostate cancer [17-20]. We are also actively developing magnetic resonance and ultrasound fusion imaging technology, and the next step will be to rely more on computer software instead of the naked eye to analyze and calibrate the lesion area and guide directional puncture to further improve the detection rate of prostate cancer [21]. In conclusion, preoperative lesion area analysis and labeling using images provided by high-field-strength magnetic resonance, and transperineal template 12+X-needle prostate aspiration biopsy guided by real-time rectal ultrasound, which combines on-the-fly puncture with directed puncture, significantly improves the rate of prostate cancer detection, with better puncture accuracy and a good safety profile, and is particularly suitable for clinical promotion and use in developing countries.