Objective: This purpose of this study is to compare the concordance, upgrading and downgrading rates of multiparametric magnetic resonance imaging cognitivetargeted prostate biopsy [COG-targeted biopsy (TB)] and a 12-core systematic prostate biopsy (SB) in order to assess the value of COG-TB in predicting final surgical pathology. Materials and Methods: In this retrospective study, the medical records of 152 consecutive patients who had undergone 12-core SB (n=105) or 12-core SB and COG-TB of suspicious lesions (n=47) and corresponding radical prostatectomy (RP) at our institution were evaluated. Biopsy and RP pathologies of the two methods were compared for downgrading, upgrading and concordance rates based on the 2014 International Society of Urological Pathology grade groups (GG). Results: For COG-TB and SB cohorts, total upgrading rates were 21.3% and 26.7%, total downgrading 10.6% and 21.9% and concordance 68.1% and 51.4%, respectively, but the differences were not statistically significant. For GG 1, 2, 3, 4 and 5, the concordance rates at COG-TB and SB were 69.6% versus 52.8%, 68.7% versus 83.1%, 75% versus 30.8%, 50% versus 9.1% and 50% versus 62.5%, respectively. There was no statistically significant difference in concordance rates regarding GG between COG-TB and SB groups. According to GG, there was also no significant difference in the rates of upgrading and downgrading of COGTB and SB. Conclusion: Although COG-TB outperforms SB in terms of pathological upgrading, downgrading and concordance rates, COG-TB has no statistically significant advantage over SB in terms of predicting final RP pathology.