Although puncture biopsy is an important method for identifying prostate cancer, a standard prostate puncture procedure has not been developed at this stage. The choice of puncture sites has been proposed by various scholars and is divided into two main categories: systematic puncture biopsy and targeted puncture biopsy. The advantages and disadvantages of systematic puncture biopsy In 1989, Hodge et al. first proposed the 6-point systematic puncture method, in which one needle is punctured at the tip, middle and bottom of the sagittal section in the paramedian area of the prostate on both sides. This method is simple and easy to perform with few complications, and has become the “gold standard” for prostate puncture biopsy. However, due to the small number of puncture points and the relatively small proportion of the circumferential area in the standard 6-point system, the false-negative rate exceeds 20%, so most scholars now advocate increasing the number of puncture points. Various scholars have proposed various schemes for the number of puncture points and the choice of puncture point locations, including 8-point, 10-point, 11-point, 12-point, 13-point, 14-point, 18-point, 21-point, and other systematic puncture biopsies. The most representative one is the five-region systematic prostate puncture method proposed by Eskew et al. in 1997, which adds two points on each side of the peripheral area and three points on the midline area to the standard 6-point systematic puncture method, for a total of 13 points; when the prostate volume exceeds 50 ml, another point is added in each area, for a total of 18 points. The increase in the number of puncture points may increase the positive rate of biopsy for cancer, but complications may also increase accordingly. Features of targeted puncture biopsy Prostate cancer usually appears as a hypoechoic nodule or an abnormal increase in local blood flow on transrectal ultrasound images. Targeted aspiration biopsy is performed to target these abnormal areas on ultrasound. In recent years, as the role of ultrasonography, magnetic resonance spectroscopy, and magnetic resonance diffusion imaging in the detection of prostate cancer has been recognized, the abnormal areas found on these imaging studies can also be used as targets to guide puncture biopsy. The advantage of targeted puncture biopsy is that it can reduce unnecessary puncture biopsy sites, but not all prostate cancers have imaging specificity, so there is also the problem of high false negative rate. We believe that a combination of 6-point systemic puncture and targeted puncture can maximize the detection rate of cancer with a minimum number of puncture points. The Department of Ultrasound at Shanghai Sixth People’s Hospital, led by Professor Yongchang Zhou, a renowned ultrasound and urology specialist, has been performing rectal ultrasound-guided trans-perineal route prostate puncture biopsies since the 1980s and has successfully performed puncture procedures on tens of thousands of patients.