目的：探讨多参数磁共振(mpMRI)与超声认知融合引导下经会阴靶向穿刺对前列腺特异抗原(PSA)＞100 ng·ml^-1及前列腺成像报告和数据系统(PI-RADS)评分5分患者诊断前列腺癌的价值。方法：回顾性分析2018年7月至2021年7月我院收治的611例疑似前列腺癌患者的临床资料，均行12针常规系统穿刺(系统穿刺)和可疑病灶的mpMRI与超声认知融合引导下的经会阴2针靶向穿刺(靶向穿刺)活检，采用卡方检验比较两种穿刺方式对前列腺癌及临床有意义前列腺癌检出率的差异；以年龄、PSA水平、PI-RADS评分分层，进一步分析其诊断效能；以根治术后病理诊断结果为金标准，比较在PSA＞100 ng·ml^-1和(或)PI-RADS 评分5分患者中，两种穿刺方式病理分级符合率。结果：系统穿刺前列腺癌及有意义的前列腺癌检出率均高于靶向穿刺，且差异均有统计学意义(均P＜0.001)。系统穿刺与术后病理符合率高于靶向穿刺，差异有统计学意义(χ²=7.143,P=0.013)；而在PSA＞100 ng·ml^-1和(或)PI-RADS 评分5分高度疑似前列腺癌的患者中，两种穿刺方式病理符合率差异无统计学意义。按照不同年龄、PSA水平、PI-RADS评分分层分析显示，虽然系统穿刺前列腺癌检出率均高于靶向穿刺，但差异无统计学意义。结论：mpMRI与超声认知融合成像引导下靶向穿刺活检在PSA＞100 ng·ml^-1和(或)PI-RADS评分5分疑似前列腺癌患者中诊断效能与系统穿刺相当，可减少患者痛苦，但仍不能替代系统穿刺活检，最好两者结合提高前列腺癌检出率，降低漏诊率。

[1] [ZK(#] CSIEGEL R L,MILLER K D.Cancer statistics,2022[J].CA Cancer J Clin,2022,72(1):7-33.
[2] XIA C,DONG X,LI H,et al.Cancer statistics in China and United States,2022:profiles,trends,and determinants[J].Chin Med J,2022,135(5):584-590.
[3] STABILE A,DELL'OGLIO P,DE COBELLI F,et al.Association between prostate imaging reporting and data system(PI-RADS) score for the index lesion and multifocal,clinically significant prostate cancer[J].Eur Urol Oncol,2018,1(1):29-36.
[4] PUECH P,ROUVIōRE O,RENARD-PENNA R,et al.Prostate cancer diagnosis:multiparametric MR-targeted biopsy with cognitive and transrectal US-MR fusion guidance versus systematic biopsy-prospective multicenter study[J].Radiology,2013,268(2):461-469.
[5] STEPHENSON S K,CHANG E K,MARKS L S.Screening and detection advances in magnetic resonance image-guided prostate biopsy[J].Urol Clin North Am,2014,41(2):315-326.
[6] XU G,XIANG L,WU J,et al.The accuracy of prostate lesion localization in cognitive fusion[J].Clin Hemorheol Microcirc,2020,74(3):223-229.
[7] PORPIGLIA F,DELUCA S,PASSERA R,et al.Multiparametric-magnetic resonance/ultrasound fusion targeted prostate biopsy improves agreement between biopsy and radical prostatectomy gleason score[J].Anticancer Res,2016,36(9):4833-4839.
[8] WEINREB J C,BARENTSZ J O,CHOYKE P L,et al.PI-RADS prostate imaging-reporting and data system:2015,Version 2[J].Eur Urol,2016,69(1):16-40.
[9] 付振宇,孙利国,张鸽,等.MRI/TRUS认知融合联合12针系统经会阴前列腺穿刺活检的临床研究[J].中华男科学杂志,2021,27(5):421-425.[ZK)]
[10] [ZK(#] 梁耿祺,谭炳超,关礼贤,等.磁共振/超声认知融合引导下经直肠前列腺靶向穿刺活检诊断前列腺癌的临床价值分析[J].临床医学工程,2021,28(10):1305-1306.
[11] 黄海鸣,徐海燕,陈燕娥,等.超声磁共振认知融合下引导前列腺穿刺术在早期前列腺癌中的应用价值[J].微创泌尿外科杂志,2021,10(1):50-54.
[12] RYAN J,BROE M P,MORAN D,et al.Prostate cancer detection with magnetic resonance imaging(MRI)/cognitive fusion biopsy:comparing standard and targeted prostate biopsy with final prostatectomy histology[J].Can Urol Assoc J,2021,15(9):E483-E487.
[13] EICHLER K,HEMPEL S,WILBY J,et al.Diagnostic value of systematic biopsy methods in the investigation of prostate cancer:a systematic review[J].J Urol,2006,175(5):1605-1612.
[14] BROWN L C,AHMED H U,FARIA R,et al.Multiparametric MRI to improve detection of prostate cancer compared with transrectal ultrasound-guided prostate biopsy alone:the PROMIS study[J].Health Technol Assess,2018,22(39):1-176.
[15] KASIVISVANATHAN V,RANNIKKO A S,BORGHI M,et al.MRI-targeted or standard biopsy for prostate-cancer diagnosis[J].N Engl J Med,2018,378(19):1767-1777.
[16] WEGELIN O,VAN MELICK H H E,HOOFT L,et al.Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies:a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration.Is there a preferred technique?[J].Eur Urol,2017,71(4):517-531.
[17] WEGELIN O,EXTERKATE L,VAN DER LEEST M,et al.The FUTURE trial:a multicenter randomised controlled trial on target biopsy techniques based on magnetic resonance imaging in the diagnosis of prostate cancer in patients with prior negative biopsies[J].Eur Urol,2019,75(4):582-590.
[18] LAI W J,WANG H K,LIU H T,et al.Cognitive MRI-TRUS fusion-targeted prostate biopsy according to PI-RADS classification in patients with prior negative systematic biopsy results[J].J Chin Med Assoc,2016,79(11):618-624.
[19] SCHAUDINN A,GAWLITZA J,MUCHA S,et al.Comparison of PI-RADS v1 and v2 for multiparametric MRI detection of prostate cancer with whole-mount histological workup as reference standard[J].Eur J Radiol,2019,116:180-185.
[20] HAFFNER J,LEMAITRE L,PUECH P,et al.Role of magnetic resonance imaging before initial biopsy:comparison of magnetic resonance imaging-targeted and systematic biopsy for significant prostate cancer detection[J].BJU Int,2011,108(8 Pt 2):E171-E178.
[21] 陈文颖,陈磊,郭倩,等.不同血清前列腺特异抗原水平下超声引导经会阴前列腺系统穿刺与认知融合多参数磁共振成像经会阴靶向穿刺对前列腺癌诊断价值的比较[J].中华超声影像学杂志,2021,30(3):243-248.
[22] 陆健斐,冯蕾,卜锐,等.磁共振-经直肠超声认知融合引导下前列腺靶向穿刺联合系统穿刺对血清前列腺特异性抗原水平4~20ng/mL患者的前列腺癌诊断有效性[J].分子影像学杂志,2021,44(6):932-936.
[23] SCHOUTEN M G,VAN DER LEEST M,POKORNY M,et al.Why and where do we miss significant prostate cancer with multi-parametric magnetic resonance imaging followed by magnetic resonance-guided and transrectal ultrasound-guided biopsy in biopsy-naïve men?[J].Eur Urol,2017,71(6):896-903.
[24] 孙鼎琪,傅强,张辉,等.多参数磁共振与经直肠超声融合前列腺靶向穿刺活检在检测PI-RADS ≥ 3前列腺癌中的临床价值[J].山东大学学报(医学版),2021,59(4):108-112.
[25] SALAMI S S,BEN-LEVI E,YASKIV O,et al.In patients with a previous negative prostate biopsy and a suspicious lesion on magnetic resonance imaging,is a 12-core biopsy still necessary in addition to a targeted biopsy?[J].BJU Int,2015,115(4):562-570.
[26] SCHOOTS I G,ROOBOL M J,NIEBOER D,et al.Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy:a systematic review and meta-analysis[J].Eur Urol,2015,68(3):438-450.
[27] 范宇,何志嵩.2020版EAU前列腺癌指南更新解读之一[J].中华泌尿外科杂志,2020,41(5):330-331.
[28] DEMIRTAŞ T,SÖNMEZ G,TOMBUL Ş T,et al.A single-center experience:does MRI-guided target prostate biopsy meet expectations?[J].Cureus,2019,11(11):e6160.