<h4>Objectives</h4>To determine the value of MRI in men with highly elevated PSA values for the exclusion of clinically significant prostate cancer (csPC).<h4>Materials and methods</h4>In this retrospective bicenter cohort study, consecutive men with PSA values ≥ 15 ng/mL and multiparametric (mp) MRI were included. This evidence concerns the gene KLK3 and Familial prostate cancer.