However, it is unknown whether this diagnostic pathway can be reproduced in clinical practice because the case mixes in RCTs rarely mirror the case mixes seen in clinical practice, and this discrepancy may result in poor external validity of results from RCTs.7 The aim of this cohort study was to investigate whether the introduction to clinical practice of MRI-targeted biopsies of men with moderately elevated PSA was associated with a decrease in prostate biopsies and whether it was associated with the detection of Gleason score 6 and Gleason score 7 or higher cancer. The gene discussed is KLK3; the disease is cancer.