Baba, DursunCoban, SonerCaliskan, AhmetSenoglu, YusufKayikci, Muhammet AliTekin, Ali2025-10-112025-10-1120252148-9580https://doi.org/10.4274/jus.galenos.2025.2025-2-9https://hdl.handle.net/20.500.12684/21500Objective: This study compares the diagnostic efficacy of 12-core and 20-core transrectal ultrasound (TRUS)-guided prostate biopsy protocols in detecting prostate cancer (PCa) and evaluates the clinical significance of extended biopsy protocols. Materials and Methods: A prospective, randomized, single-center study was conducted with 511 patients who underwent TRUS-guided prostate biopsy for suspected PCa. Patients were randomly assigned to either a 12-core biopsy group (n=248) or a 20-core biopsy group (n=263). The primary endpoint was the cancer detection rate, while secondary endpoints included clinically significant cancer detection [International Association of Urological Pathology (ISUP) grade >= 2], biopsy-pathology correlation, upgrade rates, and complication assessment. Results: The 20-core biopsy group had a significantly higher cancer detection rate (39.2%) compared to the 12-core group (28.6%). However, clinically significant cancer detection rates were similar between the groups. The 20-core protocol reduced the likelihood of ISUP grade 1 cancer being upgraded after radical prostatectomy, improving diagnostic accuracy. A strong correlation was observed between tumor burden in biopsy and radical prostatectomy specimens. Prostate-specific antigen density analysis identified an optimal cutoff value of 0.1058, providing 66.1% diagnostic accuracy. Complication rates were comparable between the protocols [5.65% (n=14), 6.46% (n=17)]. Conclusion: The 20-core biopsy protocol enhances overall cancer detection and reduces unnecessary upgrading in low-risk PCa cases, improving diagnostic precision. While multiparametric magnetic resonance imaging (MRI)-guided fusion biopsy offers high accuracy, its limited availability makes extended biopsy protocols a viable alternative, particularly in centers without MRI-based targeting methods. Further multicenter studies are needed to refine biopsy strategies for clinical practice.en10.4274/jus.galenos.2025.2025-2-9info:eu-repo/semantics/openAccessProstate biopsyprostate cancerPSA densityradical prostatectomyArticle123138145WOS:001564972600001N/A