Background: The comparison of systematic prostate biopsies (PBx) with PBx including additional cores based on magnetic resonance imaging (MRI) of lesions suspicious for prostate cancer (PCa) has been controversial. This study focuses on additional cores based on MRI findings for better cancer detection. Methods: Data were collected from 491 men who underwent transrectal ultrasound-guided PBx: a 12-core PBx (group 1: 395 cases) and a 12-core PBx plus 1–3 additional cores based on MRI (group 2: 96 cases). Comparison of two groups revealed how the additional cores taken with MRI findings affected PCa detection. Results: Group 1 had 205 cases (51.9%) and group 2 had 55 cases (57.3%) of PCa detected. This difference was not statistically significant (p = 0.3444). Only 1 of the 55 patients (1.82%) in group 2 had cancer only in the additional cores based on MRI. In other words, only 1/96 (1.04%) patients was diagnosed with PCa only by the additional core PBx. Conclusions: We suggest that systematic 12-core PBx (sextant peripheral zone + 4 transitional zone + 2 far lateral peripheral zone) can be considered an excellent tool for PCa detection and there may be no need for additional cores based on MRI findings for PCa detection.

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