Abstract:Objective To explore the diagnostic value of ultrasound-guided puncture combined with magnetic resonance imaging（MRI）for prostate cancer（PCa）and the influencing factors of missed diagnosis or misdiagnosis，to provide a reference for clinical diagnosis and treatment. Methods A total of 145 suspected PCa patients admitted to Anqing Municipal Hospital from May 2023 to March 2025 were included as the research objects. Taking the results of surgical pathological examination as the gold standard，the diagnostic efficacy of ultrasound-guided puncture，MRI，and the combined diagnosis of the two were analyzed and compared. In addition，the cases of false negatives and false positives in the combined diagnosis were included in the missed diagnosis or misdiagnosis group. Univariate and multivariate logistic analyses were used to analyze the influencing factors of missed diagnosis or misdiagnosis by ultrasound-guided biopsy combined with MRI. Results The results of surgical pathological examination confirmed that in 145 suspected patients，83 cases were diagnosed as PCa and 62 cases were diagnosed as benign prostatic hyperplasia（BPH）.The puncture results under ultrasound guidance showed that there were 80 cases of PCa and 65 cases of BPH，with an accuracy of 84.14%，a sensitivity of 84.37%，and a specificity of 83.87%. The MRI diagnosis results showed that there were 87 cases of PCa and 58 cases of BPH，with an accuracy of 82.07%，a sensitivity of 86.75%，and a specificity of 75.81% . The accuracy（93.79%），sensitivity（95.18%）and specificity（91.94%）of ultrasound-guided puncture combined with MRI in the diagnosis of PCa were significantly higher than those of ultrasound-guided puncture and MRI alone，and the differences were statistically significant（P＜0.05）. In the combined diagnosis，a total of 9 cases of false negatives and false positives were included as the missed diagnosis or misdiagnosis group. Multivariate logistic regression analysis showed that increased prostate volume（PV）（OR =1.486, 95%CI：1.092-2.021）and elevated apparent diffusion coefficient（ADC）value（OR =1.525, 95%CI：1.196-1.945）were independent risk factors for missed diagnosis or misdiagnosis（P＜0.05）；while increased levels of Prostate Imaging-Reporting and Data System（PIRADS）score（OR =0.711, 95%CI：0.544-0.930）, total prostate-specific antigen（tPSA）（OR =0.660, 95%CI：0.470-0.929）, volume transfer constant（Ktrans）（OR =0.587, 95%CI：0.381- 0.903）, and rate constant（Kep）（OR =0.721, 95%CI：0.540-0.964）were independent protective factors against missed diagnosis or misdiagnosis（P＜0.05）. Conclusion Ultrasound-guided puncture combined with MRI diagnosis can significantly improve the sensitivity，specificity and accuracy of PCa diagnosis. Moreover，tPSA，PV，PIRADS score，Ktrans，Kep and ADC value are all independent influencing factors for missed diagnosis or misdiagnosis in ultrasound-guided biopsy combined with MRI diagnosis.