The use of multiparametric MRI for prostate cancer screening is challenged by the potential missing of clinically significant cancer in areas with no visible abnormalities. We randomly biopsied areas with no visible targets under direct MRI guidance. Out of 43 biopsied areas, negative predictive value for clinically significant cancers was 90.7% suggesting a very low potential for harboring clinically significant cancers and supporting the use of mpMRI in cancer screening and active surveillance. An extended biopsy approach including sampling of areas without visible MRI abnormalities may still need to be considered prior to focal therapy.
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