The healthcare costs of prostate cancer (PCa) care were $ 11.85 billion in 2012, this is expected to increase by 42% by 2020(1, 2). The standard of care in clinical practice today to detect and diagnose prostate cancer remains a physical exam and measurement of the serum prostate specific antigen (PSA). If either are abnormal the patient will be advised to get a biopsy. The typical biopsy remains a “blinded” non-targeted sampling of the gland under ultrasound guidance (US)- the so-called TRUS or transrectal US biopsy. This approach has led to major over diagnosis and over treatment of men world-wide and more so in USA (3). MR imaging of the prostate has been performed in clinical practice for over 30 years. Recent years have seen very significant growth in prostate MR volume (Est 22% increase in 2017). MR guided interventions have been an option in clinical practice for over 20 years. So, over the past 3O years multiple advances have converged to change the prostate cancer diagnosis and treatment paradigms and now there are new exciting approaches rapidly being adopted and deployed world-wide. Earlier this year this culminated in the PRECISION trial- an exciting multi-center randomized control trial of mpMRI vs TRUS guided prostate biopsies(4). Methods: This talk will summarize the research, technology development and lessons learnt in each of the 5 areas listed. Over the past 20 years multiple trials and investigations have been performed to 1) Improve prostate MR techniques, 2) Increase the clinical applications or problems which can be solved by standardized MRI PI-RADS, 3) Interventional MR systems have been introduced and new approaches (such as MR guided focused Ultrasound (MRgFUS) ablation) to prostate interventions have been tested, validated and clinically applied, 4) multiple new prostate biopsy approaches using MR guidance have been tested, validated and clinically applied and 5) cost-effectiveness studies of the novel/new approaches have been performed. Results: Changing clinical practice is complex multi-factorial process. The MR techniques which have evolved were fundamental to each aspect of this process. Interestingly the clinical focus changed and evolved as the techniques improved. MR techniques: Early work began in the late 1980’s with small single center studies of MR techniques- field strength, coil and pulse sequence selections, in small populations of men with normal and diseased prostates. Multi-center trials for the evaluation of MR technology as applied to pre-operative staging and MR spectroscopy began in the 1990’s with several major ones (NCI funded RDOG (5) and ACRIN). Since then many others have been performed in multi-center-multi-vendor settings. The major advances have been 1) introduction of diffusion imaging and 2) overall hardware improvements with rapid scanning, increased SNR and 3) standardization by way of PIRADS v1 and V2. Clinical applications: Prostate MR is now used to detect clinically significant disease foci, used to monitor change of such lesions in active surveillance, pre-treatment staging and post therapy responses. MR interventions are routinely performed in-bore: Biopsy and focal or whole gland therapies (6). MR guided and targeted biopsies are rapidly becoming a mainstay of clinical practice with many new devices/approaches available commercially. These MR guided interventions may occur in the bore of MR scanner or out of bore using either “fusion” or cognitive approaches (7). Others have focused upon the next big challenge- development of techniques, tools and devices for image guided focal therapy- MR Thermometry is used in MR guided cryotherapy, MRgFUS and MR guided laser therapy- also multiple devices and techniques are in development and the first multi-center pivotal MRgFUS trial in the US will be discussed. Cost-effectiveness data is also available from several centers- these will be reviewed- one such study used a model-based approach using a decision-analytic Markof model, it compared the costs and impact of 2 approaches- one TRUS guided biopsy and the other mpMRI followed by MRTB with a 10-year time horizon. It concluded that adoption of MRTB in clinical practice produces health benefits for patients at reduced costs for the healthcare system (8). Summary: Five individual technical and clinical advances have converged to result in the current new added-science and added-value approach to prostate cancer diagnosis.