With the advancement of ultrasound technology, transrectal prostate ultrasound (TRUS) has been widely used in clinical practice. The initial finger-guided prostate biopsy has been eliminated; TRUS-guided prostate puncture biopsy has become the gold standard for the diagnosis of prostate disease, especially prostate cancer. In 1989, the TRUS-guided systematic 6-point puncture technique established by Dr. Hodge, an American urologist, gained clinical popularity. However, a later study on the optimal number of puncture needles found that the false-negative rate of the 6-point puncture method was high due to factors such as prostate volume and tumor focalization, and the rate of missed prostate cancer detection was 20%-30%. In order to improve the detection rate of prostate cancer, different researchers have suggested 8-point, 10-point, 12-point, 15-point, and even saturation puncture methods. 49.2% of prostate cancers were detected by the 8-point method, while the most widely used 12-point method was 51.2%. The individualized 12+X puncture protocol we used means that based on the 12-needle systematic puncture, targeted targeted puncture was performed on the high-risk areas of prostate cancer suggested by TRUS to further improve the positive puncture rate and reduce the rate of missed disease, while minimizing the number of unnecessary puncture stitches and alleviating patient pain. With regard to the choice of puncture route, since more than 80% of prostate cancers are multifocal and mostly located in the peripheral zone, small volume cancer foci are concentrated in the apical region. The transrectal prostate puncture involves a small area in the peripheral zone, the sample size is small, and the puncture needle crosses the peripheral zone, and the specimen obtained is mostly prostate tissue with metastatic hyperplasia, which is easy to be missed. The positive rate of the trans-perineal route is significantly higher than that of the trans-rectal route. The trans-perineal route has a lower rate of leakage, mainly because the puncture needle passes longitudinally parallel to the rectum through the apical part of the prostate, which allows more specimens to be obtained from the peripheral zone of the prostate, which is the site where prostate cancer is most likely to occur. Firstly, the perineal skin sterilization is easier and more precise than rectal sterilization, so the possibility of infection is greatly reduced, and no antibiotics are needed to prevent infection before surgery. Secondly, since many elderly patients need to take anti-platelet drugs such as aspirin for a long time due to coronary heart disease, trans-perineal puncture allows such patients to stop taking anti-platelet drugs for a shorter period of time, even in selected patients, thus largely avoiding the risk of cardiovascular system complications during the peri-perineal period. For patients proposing to undergo transrectal prostate ultrasound-guided prostate puncture biopsy, the following preparations should be made: use a simple bowel preparation with an anal opening at 8:00 pm before the procedure (as the ultrasound probe needs to be guided through the rectum for trans-perineal prostate puncture); fast from 10:00 pm before the procedure; take oral antibiotics for one week after the procedure to prevent infection. Please ensure that you drink 2000-2500ml of water daily. Generally, you can come to the ward 5 working days after the puncture to ask for the pathology results. After obtaining the pathology diagnosis, please make another outpatient appointment for further treatment plan according to the puncture pathology results.