目的: 比较前列腺靶向穿刺、系统穿刺、靶向穿刺+6针系统穿刺活检对前列腺影像报告和数据系统(prostate imaging reporting and data system，PI-RADS)5分患者的前列腺癌(prostate cancer，PCa)及临床有意义前列腺癌(clinically significant prostate cancer，csPCa)的诊断效能，以优化前列腺穿刺方案。方法: 回顾性分析2019年1月至2022年6月北京大学第一医院多参数磁共振(multiparametric magnetic resonance imaging，mpMRI)检查PI-RADS评分5分且行前列腺穿刺活检的患者资料。所有患者在mpMRI/经直肠超声(transrectal ultrasound，TRUS)认知融合引导下，行联合穿刺活检(靶向穿刺联合系统穿刺)。以联合穿刺活检病理结果作为金标准，对比靶向穿刺、系统穿刺及靶向穿刺+6针系统穿刺对PCa和csPCa的诊断效能。按mpMRI T分期(cT2，cT3，cT4)进行分组，通过McNemar及Cochran’s Q检验比较不同穿刺方案对PCa和csPCa的检出情况。结果: 入组585例患者，联合穿刺阳性560例(95.7%)，阴性25例(4.3%)。mpMRI T分期cT2期233例(39.8%)，cT3期214例(36.6%)，cT4期138例(23.6%)。按临床T分期分层后发现，cT2、cT3、cT4亚组中靶向穿刺与联合穿刺对PCa、csPCa检出率差异无统计学意义(PCa：P=0.203、P=0.250、P＞0.999；csPCa：P=0.700、P=0.250、P＞0.999)，靶向穿刺+6针系统穿刺与联合穿刺对PCa、csPCa检出率差异亦无统计学意义(P均＞0.999)。系统穿刺PCa和csPCa漏诊率分别为2.1%(12/560)和1.8%(10/549)，靶向穿刺分别为1.8%(10/560)和1.4%(8/549)，而靶向穿刺+6针系统穿刺检出了所有的PCa和csPCa。但与联合穿刺相比，靶向穿刺和靶向穿刺+6针系统穿刺的平均穿刺针数更少(P＜0.001)，单针阳性率更高(P＜0.001)。结论: 对于PI-RADS 5分患者，靶向穿刺及靶向穿刺+6针系统穿刺有较高的单针阳性率及PCa、csPCa检出率，可作为前列腺穿刺方案的选择之一。

Objective: To investigate the diagnostic efficacy of targeted biopsy (TBx), systematic biopsy (SBx), TBx+6-core SBx in prostate cancer (PCa) / clinically significant prostate cancer (cs-PCa) for patients with prostate imaging reporting and data system (PI-RADS) score of 5, and thereby to explore an optimal sampling scheme. Methods: The data of 585 patients who underwent multiparametric magnetic resonance imaging (mpMRI) with at least one lesion of PI-RADS score 5 at Peking University First Hospital from January 2019 to June 2022 were retrospectively analyzed. All patients underwent mpMRI / transrectal ultrasound (TRUS) cognitive guided biopsy (TBx+SBx). With the pathological results of combined biopsy as the gold standard, we compared the diagnostic efficacy of TBx only, SBx only, and TBx+6-core SBx for PCa/csPCa. The patients were grouped according to mpMRI T-stage (cT2, cT3, cT4) and the detection rates of different biopsy schemes for PCa/csPCa were compared using Cochran's Q and McNemar tests. Results: Among 585 patients with a PI-RADS score of 5, 560 (95.7%) were positive and 25(4.3%) were negative via TBx+SBx. After stratified according to mpMRI T-stage, 233 patients (39.8%) were found in cT2 stage, 214 patients (36.6%) in cT3 stage, and 138 patients (23.6%) in cT4 stage. There was no statistically significant difference in the detection rate of PCa/csPCa between TBx+6-core SBx and TBx+SBx (all P>0.999). Also, there was no statistically significant difference in the detection rate of PCa/csPCa between TBx and TBx+SBx in the cT2, cT3, and cT4 subgroups (PCa: P=0.203, P=0.250, P>0.999; csPCa: P=0.700, P=0.250, P>0.999). The missed diagnosis rate of SBx for PCa and csPCa was 2.1% (12/560) and 1.8% (10/549), and that of TBx for PCa and csPCa was 1.8% (10/560) and 1.4% (8/549), respectively. However, the detection rate of TBx+6-core SBx for PCa and csPCa was 100%. Compared with TBx+SBx, TBx and TBx+6-core SBx had a fewer number of cores and a higher detection rate per core (P < 0.001). Conclusion: For patients with a PI-RADS score of 5, TBx and TBx+6-core SBx showed the same PCa/csPCa detection rates and a high detection rates per core as that of TBx+SBx, which can be considered as an optimal scheme for prostate biopsy.