PURPOSE: The addition of systematic prostate biopsy enhances the detection of clinically significant prostate cancer compared to MRI-targeted biopsy alone. However, there is growing interest in using only MRI-targeted biopsy. We sought to evaluate PSA density as an adjunctive predictor of clinically significant prostate cancer detection in men undergoing combined biopsy and as a potential metric to stratify which patients may reasonably avoid systematic biopsies in favor of MRI-targeted biopsy only. MATERIALS AND METHODS: Men with elevated PSA and/or abnormal digital rectal exam found to have an MRI-visible prostate lesion underwent MRI-targeted and systematic prostate biopsy. Primary outcomes were clinically significant cancer detection rates by MRI-targeted, systematic biopsy, and combined biopsy across four discrete PSA density intervals (<
0.1, RESULTS: Among men with PI-RADS CONCLUSIONS: Given an approximate doubling in grade group