Research Article What is the ideal number of biopsy cores per lesion in targeted prostate biopsy? Gokhan Sonmez a , Turev Demirtas b , Sevket T. Tombul a , Figen Ozturk c , Abdullah Demirtas a, * a Erciyes University, Department of Urology, Kayseri, Turkey b Erciyes University, Department of Medical History and Ethics, Kayseri, Turkey c Erciyes University, Department of Pathology, Kayseri, Turkey article info Article history: Received 9 March 2020 Received in revised form 18 March 2020 Accepted 19 March 2020 Available online 23 April 2020 Keywords: core number prostate target biopsy abstract Background: The number of cores to be obtained in targeted biopsy (TB) is important. This study aimed to evaluate the TB outcomes in suspicious prostate lesions classified according to the Prostate Imaging Reporting and Data System (PI-RADS) and to determine the ideal number of biopsy cores per lesion. Methods: This retrospective study included patients who underwent multiparametric magnetic reso- nance imagingeguided fusion prostate biopsy owing to increased serum prostate-specific antigen (PSA) levels and suspicious digital rectal examination outcomes in our institute. Patients with PI-RADS <3 lesions, PSA levels >10 ng/ml, and a prior diagnosis of prostate cancer (PCa) (active surveillance) were excluded from the study. The number of biopsy cores to be obtained from each lesion was determined by the clinician. Results: The study included a total of 418 patients and 684 lesions. Among PI-RADS 3 lesions, clinically significant PCa (sPCa) detection rate was similar in the lesions from which 2 and 3 cores were obtained (9.1% and 10.0%, respectively), whereas it was relatively higher in the lesions from which 4 biopsy cores were obtained (18.5%). Among PI-RADS 4 lesions, sPCa detection rate was similar in the lesions from which 3 and 4 cores were obtained (35.6% and 32.3%, respectively), whereas it was relatively lower in the lesions from which 2 biopsy cores were obtained (17.9%). Among PI-RADS 5 lesions, however, sPCa detection rate was similar in the lesions from which 2, 3, or 4 cores were obtained (47.6%, 46.0%, 48.9%, respectively). Conclusion: The results indicated that the ideal number of cores to be obtained from each suspicious lesion in TB depends on the characteristics of the lesions. Accordingly, while obtaining 2e3 biopsy cores could be adequate in PI-RADS 4 and 5 lesions, which have a serious risk of cancer, a minimum of 4 biopsy cores should be obtained from PI-RADS 3 lesions to ensure accurate histopathological results. Clinical trial number (ClinicalTrials.gov)NCT03936296. © 2020 Asian Pacific Prostate Society. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 1. Introduction Prostate cancer (PCa) is commonly diagnosed by digital rectal examination (DRE), the serum prostate-specific antigen (PSA) test, and prostate needle biopsy (PNB). 1 Multiparametric magnetic resonance imaging (mpMRI)eguided fusion prostate biopsy (FPB) is a PNB technique that has been shown as an effective approach in numerous studies. 2 FPB is typically performed as targeted biopsy (TB) or in combi- nation with TB or standard prostate biopsy (SPB). 3 The literature recommends the use of 2e4 cores per suspicious lesion in TB. 4,5 However, the ideal number of biopsy cores to be obtained from each lesion with regard to the type and characteristics of the lesion remains controversial, and there is no consensus in the literature regarding this controversy, which is a major concern in clinical practice. 6e9 As a matter of fact, however, obtaining an insufficient number of biopsy cores from suspicious lesions may lead to false negative results, whereas obtaining an excessive number of biopsy * Corresponding author. Erciyes Üniversitesi, Gevher Nesibe Hastanesi, 1. Kat Üroloji Klini gi, Melikgazi, Kayseri, Türkiye. E-mail addresses: gokhans72@hotmail.com (G. Sonmez), turevdemirtas@ hotmail.com (T. Demirtas), toltom@gmail.com (S.T. Tombul), ozfigen@erciyes.edu. tr (F. Ozturk), mesane@gmail.com (A. Demirtas). Contents lists available at ScienceDirect Prostate International journal homepage: https://www.journals.elsevier.com/prostate-international https://doi.org/10.1016/j.prnil.2020.03.004 p2287-8882 e2287-903X/© 2020 Asian Pacific Prostate Society. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Prostate International 8 (2020) 112e115