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However, MRI characteristics of the prostate in younger men remain underexplored. This study aimed to characterize prostate MRI features in a young, asymptomatic male cohort undergoing contrast-free biparametric MRI for prostate cancer screening, to determine the detection rate of clinically significant prostate cancer, and to identify clinical and imaging predictors of clinically significant disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 659 prostate MRIs were acquired; after excluding men who declined biopsy, 641 participants formed the final cohort. Peripheral-zone signal patterns on T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps were assessed by two blinded radiologists. PI-RADS scores were assigned independently. Men with PI-RADS\u2009\u2265\u20094 were offered targeted MRI\u2013TRUS fusion biopsy (PI-RADS 3 in case of PSAD\u2009\u2265\u20090.16). Multivariable logistic regression was performed to identify independent predictors of csPCa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median PSA 1.02\u2009ng\/mL (IQR 0.58\u20132.03) and PSA density (PSAD) 0.03\u2009ng\/mL\/mL (IQR 0.02\u20130.05). The most common peripheral-zone appearance was heterogeneous T2 hypointensity (74.7%), homogeneous DWI hyperintensity (59.4%), and homogeneous ADC hypointensity (66.1%). PI-RADS distribution was: 0.5% PI-RADS 1, 81.1% PI-RADS 2, 14.2% PI-RADS 3, 3.6% PI-RADS 4, and 0.6% PI-RADS 5. Forty-one men (6.4%) underwent biopsy, yielding 5 ciPCa, 23 csPCa, and 13 negative results, corresponding to csPCa in 3.6% of the entire cohort. In multivariable analysis, PSAD\u2009\u2265\u20090.15\u2009ng\/mL\/mL, PI-RADS 4\u20135, and family history were independently associated with csPCa (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Contrast-free bpMRI effectively characterizes prostate morphology in younger men and identifies csPCa at an early stage. PSAD, PI-RADS category, and family history significantly enhance risk stratification, supporting the integration of bpMRI-based approaches into future MRI-first screening strategies for younger, asymptomatic populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41391-026-01116-5","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T16:54:25Z","timestamp":1778691265000},"page":"846-853","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Contrast-free MRI-first screening in young asymptomatic men: Prostate characteristics and cancer detection rates"],"prefix":"10.1038","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4395-2872","authenticated-orcid":false,"given":"Emanuele","family":"Messina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Laschena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Borrelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Mezzapesa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Lucciola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2877-3169","authenticated-orcid":false,"given":"Luca","family":"Giuliani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Giuliani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bicchetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Sciarra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8466-918X","authenticated-orcid":false,"given":"Valeria","family":"Panebianco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"1116_CR1","first-page":"209","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. 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