Objective：To compare the diagnostic efficacy of prostate targeted biopsy alone and systematic targeted biopsy in patients with high PI-RADS score of 4~5. Methods：From1 July 2019 to 1 June 2022, 439 patients with prostate PI-RADS score of 4-5 who received prostate targeted biopsy alone and combined system targeted biopsy in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The patient’s median age was 70(42,90) yeas. median prostate specific antigen was 11.7（1.4，49.5）ng/ml，median prostate volume was 37.6（14.0，201.1）ml, Median prostate-specific anti-density was 0.3（0.04，3.0）ng/ml2. There were 283 patients with PI-RADS score of 4 and 156 patients with PI-RADS score of 5. Two urologists independently performed bp-MRI-TRUS cognitive fusion targeting and targeting combined system biopsy in each patient. The detection of CsPCa-A by different biopsy methods were compared by χ2 test or Fisher's exact test. Outcome：341out of 439 cases (77.7%) were positive, 98 cases (22.3%) were negative, Among of them, the positive rate of single targeted biopsy in the diagnosis of prostate cancer was 73.0% (189/259), and the positive rate of targeted combined systematic biopsy was 84.4% (152/180). Of the 439 cases，294 (67.0%) were diagnosed with CsPCa-A, and there was no significant difference in the detection rate of CsPCa-A between single targeted biopsy and targeted combined systematic biopsy [63.3% (164/259) and 77.2%(127/180), P=0.05]. If only targeted biopsy was performed, 15.6% (28/180) of CsPCa-A would be missed. In patients with a PI-RADS score of 4, there was significant difference in the detection rate of CsPCa-A between targeted biopsy alone and targeted combined systematic biopsy [58.9% (86/146) and 70.8% (97/137), P=0.04]. In patients with a PI-RADS score of 5, there was no significant difference in the detection rate of CsPCa-A between single targeted biopsy and targeted combined systematic biopsy [69.0%（78/113）与76.7%（33/43）,P=0.3]。 When 0＜PSA ≤20ng/ml, the difference in the detection rate of CsPCa-A between pure targeted biopsy and targeted combined systematic biopsy was statistically significant[60.9%（117/192）与71.4%（105/147）,P=0.04]。When 20＜PSA≤50, there was no significant difference in the detection rate of CsPCa-A between single targeted biopsy and targeted combined systematic biopsy[70.1%（47/67）与75.8%（25/33）,P=0.6]。When the PI-RADS score was 4 and 0＜PSA ≤20ng/ml, the difference in the detection rate of CsPCa-A between single targeted puncture and targeted combined systematic puncture was statistically significant [58.1%（72/124）与70.7%（82/116）,P=0.04]；When the PI-RADS score was 4 and 20＜PSA ≤50ng/ml, there was no significant difference in the detection rate of CsPCa-A between single targeted puncture and targeted combined systematic puncture [63.6%（14/22）与76.2%（16/21）,P=0.4]；When the PI-RADS score was 5 points, 0 20ng/m or PI-RADS score is 5, a single targeted biopsy can replace the system combined with targeted biopsy.