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71; 95% CI 1.21-6.17, p = 0.016) in a multivariable model but did not improve upon a model with only clinical factors (AUC 0.768 versus 0.762). In 194 fusion biopsies, higher grade cancer was found in targeted cores in 21 (11%) instances, while 25 (13%) had higher grade cancer found in the systematic cores. CONCLUSIONS This study adds the largest cohort data to the body of literature for MRI in active surveillance, recommending systematic biopsy in patients with a negative MRI and the inclusion of systematic biopsy in patients with a po