Fig. 1.

Diagnostic flowcharts of men with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE), with combinations of risk stratification w/o prostate MRI. Risk assessment with a PSA only, b multivariate risk prediction tools only, c prostate MRI only, and d multivariate risk prediction tools: when systematic biopsy is indicated subsequently a prostate MRI is performed to indicate a combined targeted biopsy, e multivariate risk prediction tools incorporating prostate MRI for biopsy-decision management (systematic, targeted, or both), and f multivariate risk prediction tools (step 1) may indicate systematic biopsy and subsequently a prostate MRI is performed. Based on the outcome parameters of prostate MRI incorporated in MRI-multivariate risk prediction tools, these tools may navigate into further biopsy testing or into deferring biopsy testing. PCa prostate cancer, PI-RADS MRI suspicion score, TBx MRI-targeted biopsy, SBx systematic biopsy, AS active surveillance