Re: Lars Boesen, Nis Nørgaard, Vibeke Løgager, et al. Prebiopsy Biparametric Magnetic Resonance Imaging Combined with Prostate-specific Antigen Density in Detecting and Ruling out Gleason 7-10 Prostate Cancer in Biopsy-naïve Men. Eur Urol Oncol 2019;2:311-9 (European Urology Oncology)

We read the excellent article by Boesen et al [1] on the potential for a model combining biparametric magnetic resonance imaging (bpMRI) and prostate-specific antigen density (PSAd) for detection of significant prostate cancer (sPCa) in biopsy-naïve men. Their best strategy was to restrict biopsies to those men with highly suspicious lesions (Prostate Imaging-Reporting and Data System [PI-RADS] v.2 score >=4) or PSAd >=0.15ng/ml/cm3. Among 808 men, this strategy reduced the number of biopsies by 41% (329/808), overdiagnosis by 45% (79/177), and misdiagnosis of sPCa (International Society of Urological Pathology grade group >1) by 5% (17/329).