Following image acquisition, the subsequent crucial step involves identifying areas deemed suspicious for biopsy. To get the most yield from histological examination, several factors should be considered, like the level of suspicion on mpMRI (PI-RADS), lesion size, and distance from the prostate capsule (possibility of extra­prostatic extension). The dominant lesion is characterized as the lesion exhibiting the high­est PI-RADS score. Similar to evidence from high- volume centers [9], in our institutional analysis involving 392 patients with a total of 521 lesions that were biopsied with a single urologist with more than 11years of experience with FB, the positive predictive values (PPV) for PI-RADS 5, 4, and 3in detecting any PCa and csPCa were determined to be 0.80, 0.55, and 0.24, and 0.63, 0.33, and 0.09, respectively [5]. Even though the PI-RADS system is not perfect and continues to be iterated to ensure its continued strong diagnostic performance, the degree of suspicion for clinically signicant prostate cancer has been a predictor of FB suc­cess, and the latest PI-RADS version (2.1) pro­vides higher PPV, especially for lesions originating in the TZ [9, 10]. Some studies pro­posed that in addition to the PI-RADS score, accounting for patient characteristics (i.e., age, PSA density, history of prostate biopsy, race, and family history) could yield a better assess­ment of suspicion and csPCa detection, espe­cially for PI-RADS 3 and 4 lesions [11–14].