Optimizing Combined Magnetic Resonance Imaging-Targeted and Systematic Biopsy Strategies: Sparing the Multiparametric Magnetic Resonance Imaging-Negative Transitional Zone in Presence of Exclusively Peripheral Multiparametric Magnetic Resonance Imaging-Suspect Lesions.

A peripheral TBx plus SBx without any transitional zone sampling protocol (B) yields similar csPCa detection rates as the standard extended protocol (A) but may reduce biopsy-related morbidity. This zone-dependent biopsy strategy warrants prospective evaluation to optimize the extent of systematic biopsies in presence of suspicious mpMRI lesions.