Abstract Background Index lesion‐focused ipsilateral systematic biopsy (iSB) has been proposed as a core‐reduction alternative to MRI‐targeted biopsy combined with systematic biopsy (TB + SB) for prostate cancer, but prospective multicenter validation is limited. Methods This prospective multicenter trial (NCT06584279) enrolled biopsy‐naive men with Prostate Imaging Reporting and Data System (PI‐RADS) ≥4 lesions or PI‐RADS 3 plus prostate‐specific antigen (PSA) density ≥0.15 ng/mL/cm 3 . All und