Men with a serum PSA of >3.0 ng/ml are typically referred for further diagnostic investigations for prostate cancer; however, many either will not have the disease or will have low-risk tumours and might have adverse events from unnecessary diagnostic procedures and/or overtreatment. Now, an update from the ongoing GÖTEBORG-2 study demonstrates that men without suspicious lesions detected on MRI of the prostate can safely forego further diagnostic procedures.

In GÖTEBORG-2, a total of 13,153 men 50–60 years of age are undergoing serum PSA monitoring at 2, 4 or 8 years after initial testing depending on baseline results, with a serum PSA of >3.0 ng/ml at any round of testing as the threshold for further investigation. These men were randomly allocated 1:1 to undergo prostate MRI followed by systematic biopsy sampling regardless of MRI findings versus only targeted biopsy sampling if suspicious lesions were detected on MRI. Detection of clinically insignificant (International Society of Urological pathology (ISUP) grade 1) prostate cancer was the primary end point. Detection of clinically significant (ISUP grade ≥2) prostate cancer was a secondary end point.