Extending Current Guideline-recommended Prostate-specific Antigen Density Thresholds for Improving Benefit/Harm Balance in Risk-based Magnetic Resonance Imaging–directed Prostate Cancer Diagnosis, from the Community-based Multicentre MR-PROPER Study

In a community-based diagnostic setting (24% GG ≥2 disease), applying a post-MRI PSA density threshold of ≥0.20 rather than the recommended threshold of 0.10 ng/ml² in men with PI-RADS 3 lesions reduces unnecessary biopsies while maintaining oncological safety. This improved the benefit-to-harm ratio of risk-based PCa diagnostics, particularly in cancer-averse settings. For MRI indication, a pre-MRI PSA density threshold of ≥0.10 ng/ml² supports a favourable benefit-to-harm ratio, though with narrow safety margins. These findings may inform risk-adapted strategies, particularly in biopsy-averse settings.