Traditional diagnosis of prostate cancer (Pca) is based on serum PSA level and digital rectal examination (DRE) findings [1]. Unfortunately, this approach has resulted in low performance with high rate of unnecessary biopsies, increased detection of indolent neoplasms with missing some clinically significant tumors [2,3]. The introduction of multi parameter magnetic resonance imaging (mpMRI) of the prostate in combination with MRI/TRUS fusion (targeted) biopsy resulted in better performance. i.e., absolute detection of more clinically significant prostate cancer (csPca), less detection of indolent prostate cancer and a significant reduction of the number of biopsies performed [4,5]. Despite the improved detection of clinically significant prostate cancer by using mpMRI there is often discordance between the imaging and the targeted biopsy results, the difference is mainly attributed to three factors: Inaccurate interpretation of the mpMRI imaging, inadequate sampling of the targeted lesion during the MRI/TRUS fusion biopsy and pathology related factors that may lead to error in the histology report [6,7]. Most of the available information in the literature comes from highly experienced referral centers leaving the “real world” prostate cancer detection rate unknown.

The aim of the current study was to document the performance of MRI/TRUS fusion biopsy of the prostate using the Navigo™ system (a relatively new software) in contemporary cohort of patients in nonreferral centers which reflects the real-world. Furthermore, we evaluated the need to include systematic sampling in addition to the targeted lesions biopsy.