There are many ways to perform a puncture biopsy of the prostate. The biopsies can be divided into ultrasound-guided and non-ultrasound-guided blind biopsies, and trans-perineal and trans-rectal biopsies according to the location of the puncture. In clinical practice, ultrasound-guided transrectal aspiration biopsy has gradually become the mainstream prostate aspiration biopsy modality with its incomparable advantages. The patient’s position during ultrasound-guided prostate puncture biopsy (lying on the side with knees and hips flexed) is the same as during transrectal ultrasound, and the ultrasound probe used to monitor and guide the puncture needle is similar, so no additional pain is added. With ultrasound guidance, the puncture is more accurately localized, the extent of the lesion can be roughly defined, targeted, which facilitates pathological grading and helps to detect some areas that cannot be penetrated by blind puncture. At the same time, because the rectum is not sensitive to pain, patients suffer little pain and generally do not need anesthesia, and most patients can tolerate it. In addition, because of the simplicity and precision of this method, complications such as hematuria, rectal bleeding, infection, and urinary retention are rare. In order to prevent and reduce complications and improve safety, ultrasound-guided transrectal prostate puncture biopsy usually requires the following preparations: 1. preoperative tests: coagulation, blood, urine and fecal routine, electrocardiogram, and in some elderly patients, further assessment of cardiopulmonary function; 2. preoperative preparation: application of laxative drugs and oral antibiotics; 3. exclusion of relevant conditions temporarily unsuitable for puncture: coagulation dysfunction (anticoagulant drugs such as aspirin need to be stopped for more than 1 week), recent prostatitis attacks, and severe anorectal disease. With these preparations, the overall incidence of prostate puncture complications has been reduced to less than 1% in some medically experienced units. In addition, many patients are concerned about whether puncture can cause tumor dissemination. Scientific and systematic studies have been conducted by foreign scholars, but so far no information has been found to report any cases of tumor metastasis due to puncture. The number of stitches used for prostate puncture is an important factor in the diagnostic efficacy and complications of prostate puncture. There is a correlation between the number of puncture stitches used for prostate puncture biopsy and the rate of positive diagnosis and risk of complications. Some studies have shown that the diagnostic positivity rate is significantly higher for puncture biopsies with more than 10 stitches than for those with less than 10 stitches, but without a significant increase in complications. It is currently suggested that the number of puncture stitches needs to be selected individually based on PSA and patient specificity. Who needs a prostate puncture biopsy? Prostate puncture biopsy is an important method for the pathological diagnosis of prostate cancer. It is currently believed that prostate puncture is needed when the following conditions occur: 1. /4. Prostate-specific antigen (PSA) between 4 and 10 ng/ml and the ratio of free PSA to total PSA is less than 0.16 or the ratio of total PSA to prostate volume (prostate volume can be measured by transrectal ultrasound) is greater than 0.15. If the PSA is between 4 and 10 ng/ml, then close observation may be performed first. Since bleeding from prostate puncture may affect the clinical staging of imaging (especially MRI), prostate puncture should be performed after MRI.