Elkhoury FF, Felker ER, Kwan L, et al. - Through a paired-cohort trial comparing biopsy methods in 248 men with MRI, researchers ascertained the cancer detection rate (CDR) of targeting MRI-visible lesions vs systematic prostate sampling in the diagnosis of clinically important prostate cancer in men who were biopsy naive. In the paired cohort group, the overall CDR was 70 %, accomplished by combining systematic and targeted biopsy outcomes. In the group without MRI-visible lesions, the CDR by systematic sampling was 15%. CDRs differed from 47% when using cognitive fusion biopsy alone, to approximately 60% when using a systematic biopsy or either fusion method alone, to 70% when combining systematic and targeted biopsy, in the paired-cohort group. Discordance of tumor locations implies that the various biopsy methods discover distinctive tumors. Hence, combining targeting and systematic sampling gives the highest sensitivity for the discovery of clinically important prostate cancer. The Prostate Imaging Reporting & Data System version 2 grade and prostate-specific antigen density for all biopsy methods, were directly correlated with CDRs, and prostate volume was inversely related. Therefore, in men undergoing first-time prostate biopsy, an MRI-visible lesion recognizes those with an increased risk of clinically important prostate cancer. Combining targeted and systematic biopsy proposes the best possibilities of identifying cancer.