A risk‐organised model for clinically significant prostate cancer early detection

Evidence that specific mortality of PCa decrease when clinically significant PCa (csPCa) is early detected has moved the focus of PCa screening towards csPCa. 1 This paradigm shift has occurred since the spread of multiparametric magnetic resonance imaging (mpMRI), which allows to avoid unnecessary prostate biopsies and overdetection of insignificant PCa (iPCa) in a cost-effective way. 2,3 However, because suspicion of PCa remains based on elevated serum prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE), there has been an increased demand for mpMRI that cannot always be performed. Experienced radiologists, reporting with an updated version of PI-RADS, obtain a negative predictive value of mpMRI that reaches up to 95%, which makes it possible to avoid prostate biopsies in men with suspected PCa with a PI-RADS