Among men with any significant MRI lesion (PIRADS score 3–5), none of the cut-offs used, identified a group of men with < 11% risk of ISUP GG ≥ 2 cancer (resembling the risk among men with PSA ≤ 3 ng/ml in a screening population [7, 16, 17]). This evidence concerns the gene KLK3 and cancer.