In article by Pirkorny et al published in Eur Urol (2014) the authors report a study of223 consecutive patients referred with raises PSA. All had an MRI and random biopsies with additional guided biopsies for suspicious lesions. 63.7% were diagnosed with cancer. Random biopsies detected 56.5% including 37.3% with low risk disease. Guided biopsies would have 69.7% with only 6.1% low risk. Estimated NPV for significant cancer was 71.9% for random and 96.9% for guided biopsies. Follow up of this cohort is required.