Meissner VH, Rauscher I, Schwamborn K, et al. - Based on a high suspicion of significant prostate cancer (PC) in both multiparametric magnetic resonance imaging (Prostate Imaging Reporting and Data System score ≥4) and prostate-specific membrane antigen positron emission tomography (PET score ≥4 on a five-point Likert scale and maximum standardized uptake value ≥4.0), the feasibility of primary radical prostatectomy (RP) without prior biopsy was reported among 25 patients who took part in this case series.

• Postoperative histopathology of all 25 patients demonstrated International Society of Urological Pathology grade ≥2 PC.

• Patient- and lesion-based comparisons with histopathology of the prostate specimen were documented.

• Findings of this case series could trigger the discussion regarding RP without prior biopsy as a possible choice in well-selected cases.

• It was clearly emphasized that this practice should not be considered as a standard procedure at the moment, and further confirmation of results is needed.