The second version of the Prostate Imaging Reporting and Data System (PIRADSv2) is the new standard for interpreting prostate MRI. Validation studies have been performed of this scheme, but many have used targeted biopsies as the reference standard. Our validation study is unique in utilizing 3D trans-perineal mapping biopsy (3DTMB) as the reference standard. With a total of 41 MRI lesions, PI-RADSv2 score = 5 lesions had a PPV for cancer of 1.0. However, when all significant lesions (PI-RADSv2 score ≥3) were included, the PPV is 0.29, with equal PPV of PI-RADS 3 and 4 lesions.