Figure 2 suggests that if PIRADS 3 lesions were excluded from BX, 56.5% PIRADS 3 lesions with csPCa would have been missed, but the absolute number of missed lesions in our study would be only 13. Schenker et al. have reported that although PIRADS 3 lesions have an equivocal probability of csPCa, their study found an overall PCa detection rate of only 26.8% and 14.6% for csPCa in these lesions, respectively34, while Nicola et al. have suggested that PSA density, age, and tumor volume should be considered when deciding on BX of PIRADS 3 lesions.35 This evidence concerns the gene KLK3 and posterior cortical atrophy.