Abstract: Obejective  To explore whether it is possible to detect the ¹²³I prostate-specific membrane antigen(PSMA) radiation value of the puncture tissue during prostate biopsy to achieve real-time,rapid,and accurate identification of benign and malignant prostate tissues,so as to improve the current clinical biopsy strategy and achieve  accurate diagnosis of prostate cancer during operation with fewer puncture needles.Method In this prospective,diagnostic trial,we included 29 patients with suspected prostate cancer.All patients underwent transperineal biopsy guided by ultrasound within 24 hours after injection of ¹²³I PSMA，a total of 435 punctures were performed.The radiation value of punctured tissue was measured in real-time with a gamma counter.〖JP2〗Pearson test is used to correlate radiation value with histopathology.Result The median radiation value of prostate cancer tissue (1906.50cpm) was significantly higher than that of benign prostate tissue (415.00cpm).The optimal cut-off value for distinguishing benign and malignant prostate tissues was 828.50cpm.The median radiation value of clinically significant prostate cancer tissue (2652.50cpm) was significantly higher than that of clinically insignificant prostate cancer (1386.00cpm).The optimal cut-off value for distinguishing clinically significant and clinically insignificant prostate cancer tissues was 1767.00cpm.In additional,there was a significant positive correlation between the radiation value of puncture tissue and ISUP pathological grade (r=0.834).Conclusion It is preliminarily confirmed that detection of ¹²³I PSMA radiation value of prostate puncture tissue can realize real-time,rapid and accurate identification of benign and malignant prostate tissues during operation.

Key words: prostate cancer, prostate-specific membrane antigen, prostate biopsy, targeted puncture, systematic puncture