T. Barrett, et al. - During a 30-month period, 1,483 patients with prostate cancer suspicion were assessed by researchers to assess the impact of pre-biopsy magnetic resonance imaging (MRI) on cancer diagnostic times and to inform on MRI-directed pathology outcomes. Upfront MRI was conducted in 745 patients with 332 MRIs in the 15 months before the dedicated scanning slots (group 1), and 413 in the 15 months after the introduction (group 2). A total of 44.4% of subjects avoided biopsy. Out of 833 MRIs, 484 were negative and 37.4% of these patients had a biopsy with a negative predictive value of 92.8% for Gleason ≥3+4 and 98.3% for ≥4+3. Overall prostate cancer prevalence was observed as 34.3%. Any cancer was present in 78.9% of 323 MRI-positive individuals. Within 28 days, out of the 1,483 patients, 1,232 performed all diagnostic tests. Upfront MRI individuals met this standard in 621, growing from 66.9% to 81.1% with reserved slots (group 2) with a lower diagnostic time from median 25.5 to 20.9 days. In comparison to transrectal, transperineal biopsies met the 28-day standard in significantly fewer cases. Reserved MRI slots lowered time-to-diagnosis, and biopsy is safely avoided in a significant proportion of men via upfront MRI, whilst sustaining expected clinically significant cancer detection rates.