Multiparametric MRI is increasingly being used for the detection of prostate cancer in patients with a suspicion of prostate cancer (PCa) but limitations such as long acquisition time remains (1). Our objective was to investigate the accuracy of a rapid MRI protocol and simple biopsy procedure in patients with a clinical suspicion of PCa (IMPROD= IMPROved prostate cancer Diagnosis – Combination of Magnetic Resonance Imaging and biomarkers)Men with a clinical suspicion of PCa were enrolled to the prospective, controlled, registered (ClinicalTrials.gov Identifier NCT01864135) clinical trial (Figure 1). After signing an informed consent, MRI scanning was performed followed by prostate biopsies (Figure 2). The MRI examination was performed using a 3T MR scanner (3T Verio, Siemens, Erlangen, Germany). Only routinely available MR acquisition and post-processing methods were used allowing wide application of our MRI protocol in other centers. The overall imaging time including shimming and calibration was approximately 15 minutes. No intravenous contrast agent or endorectal coil were used. T2-weighted imaging (T2w) in transversal and sagittal planes were performed as previously described (2), transversal T2w - TR/TE 8640/101 ms, acquisition voxel size 0.6×0.6×3.0mm3; sagittal T2w - TR/TE 8640/101ms, acquisition voxel size 0.7×0.6×3.0mm3. Diffusion weighted imaging (DWI) data sets were collected in three separate acquisitions using a spin echo double refocused sequence with epi read-out, bipolar gradient scheme and the following parameters: 1. TR/TE 5543/80 ms, b values 0, 100, 200, 300, 500 s/mm2, acquisition voxel size 2.0×2.0×3.0mm3, no intersection gaps; 2. TR/TE 5000/87 ms, b values 0, 1500 s/mm2, acquisition voxel size 2.0×2.0×5.0mm3, no intersection gaps; 3. TR/TE 5000/87 ms, b values 0, 2000 s/mm2, acquisition voxel size 2.0×2.0×5.0mm3, no intersection gaps. Suspicious lesions in MRI were reported using Likert scoring systems as follows: 1- significant cancer is highly unlikely to be present, 2- significant cancer is unlikely to be present, 3- significant cancer is equivocal, 4- significant cancer is likely to be present, 5- significant cancer is highly likely to be present. Transrectal ultrasound (TRUS) biopsies were performed cognitively, without MRI-TRUS fusion. In a case of MRI suspicious lesion (Likert score 3-5), initially 2 targeted biopsy (TB) cores were aimed at the dominant MRI-lesion followed by 6+6 systematic biopsies (SB). Finally, 2 biopsy cores for biomarker research were taken (Figure 1). All biopsy cores were reported separately (core length, cancer length, Gleason score) by 2 expert GU-pathologist using 2005 International Society of Urological Pathology Modified Gleason Grading System modified Gleason grading system (3). The primary end point was a diagnostic accuracy of the following models for predicting PCa and clinically significant PCa (SPCa): 1. blood model: PSA, age, 5-alpha-reductase inhibitors use. 2. visit model: PSA, age, 5-alpha-reductase inhibitors use, digital rectal examination; 3. transrectal ultrasound model: PSA, age, 5-alpha-reductase inhibitors use, digital rectal examination, TRUS findings, prostate volume (as measured by TRUS), PSA density. 4. MRI model: PSA, age, 5-alpha-reductase inhibitors use, digital rectal examination, TRUS findings, prostate volume (as defined by TRUS), PSA density, Likert score. The following three definitions of SPCa were used: definition no. 1- Gleason score 3+4 or higher, definition no. 2- Gleason score of 4+3 or higher and 3+4 with >=50% of any core containing cancer and/or >=4 SB positive for cancer (1), definition no. 3- Gleason score of 4+3 or higher. Receiver operating characteristic curve analysis with area under the curve (AUC) values were used to evaluate ability of the models to predicting PCa and SPCa. Likert scores 1-2 were combined in the model predictions resulting into 3 degrees of freedom (Likert scores: 1-2, 3, 4, 5). Logistic regression models were estimated using variables as defined above. The “gold standard” was based on TB and SB findings and in 3 patients based on follow up TB findings. P-values less than 0.05 were considered statistically significant. All analyses were conducted using R version 3.2.0 (R Foundation for Statistical Computing, Vienna, Austria).In total, 175 men were prospectively enrolled while 161 men were included in the final analyses (Figure 2). The MRI model significantly outperformed all other models in PCa and SPCa detection (Figure 3). Only 4 (3%) and 2 (2%) men had Likert score 1-2 and presented with SPCa according to the definition no. 1 (Figure 4) and definition no. 2 (Figure 5) while none had SPCa according to the definition no. 3.Rapid pre-biopsy biparametric MRI (T2wi+DWI) is an accurate tool for the management of patients with a clinical suspicion of PCa based on PSA and/or abnormal digital rectal examination.