自愿 PCa 筛查经常导致过度使用不必要的诊断测试，增加发现惰性 PCa 的风险，并导致各个国家卫生系统无法承担费用。在这种情况下，意大利泌尿外科学会 (Società Italiana di Urologia, SIU) 提出了一个有组织的流程图，指导医生改善重要 PCa 的早期诊断，避免不必要的诊断测试和前列腺活检。根据现有证据和国际指南 [即欧洲泌尿外科协会 (EAU)、美国泌尿外科协会 (AUA) 和国家综合癌症网络 (NCCN)] 关于 PCa，由意大利泌尿外科协会 (SIU, Società Italiana di Urologia) 选出的专家泌尿科医生小组提出了一些发展的适应症基于主要用于临床实践的诊断测试的逐步诊断途径。最终文件提交给六位泌尿科专家进行外部修订和批准。此外，最终文件已与患者倡导团体共享。对于自愿男性和 PSA 值升高（>3 ng/mL）有症状的患者，专家组强烈建议在尿培养证实没有尿路感染的情况下使用抗生素。 DRE 仍然是泌尿科体检的关键部分，可帮助泌尿外科医生正确解读 PSA 升高情况，并在存在可疑 PCa 的情况下优先执行多参数磁共振成像 (mpMRI)。可以进一步监测 mpMRI 阴性且临床怀疑 PSA 较低的男性（PSA 密度 < 0.20 ng/mL/cc、DRE 结果阴性、无家族史）。 mpMRI 阴性且 PCa 风险较高的男性（家族史、可疑 DRE、PSAD>0.20 ng/mL/cc 或 PSA>20 ng/mL）应考虑进行系统前列腺活检。虽然 PI-RADS 4-5 病变代表前列腺活检的强烈指征，但 PI-RADS 3 病变应根据 PSAD 值进一步分层，并在 PSAD 高于 0.20 时进行前列腺活检。应大力考虑对进行前列腺 mpMRI 的放射科医生和中心进行认可、认证和质量审核。还应在诊断路径中评估 MRI 检查的可及性和/或等待名单。专家组建议将经会阴或经直肠靶向加系统活检作为标准治疗。科学界必须支持使用共享诊断途径，以提高对重要 PCa 的早期发现，减少晚期 PCa 的延迟诊断。此外，共享的诊断途径可以减少抗生素的错误使用、不必要的实验室和放射检查以及前列腺活检的数量。

Voluntary PCa screening frequently results in excessive use of unnecessary diagnostic tests and an increasing risk of detection of indolent PCa and unaffordable costs for the various national health systems. In this scenario, the Italian Society of Urology (Società Italiana di Urologia, SIU) proposes an organized flow chart guiding physicians to improve early diagnosis of significant PCa avoiding unnecessary diagnostic tests and prostate biopsy.According to available evidence and international guidelines [i.e., European Association of Urology (EAU), American Association of Urology (AUA) and National Comprehensive Cancer Network (NCCN)] on PCa, a Panel of expert urologists selected by Italian Society of Urology (SIU, Società Italiana di Urologia) proposed some indications to develop a stepwise diagnostic pathway based on the diagnostic tests mainly used in the clinical practice. The final document was submitted to six expert urologists for external revision and approval. Moreover, the final document was shared with patient advocacy groups.In voluntary men and symptomatic patients with elevated PSA value (>3 ng/mL), the Panel strongly discourage the use of antibiotic agents in absence of urinary tract infection confirmed by urine culture. DRE remains a key part of the urologic physical examination helping urologists to correctly interpret PSA elevation and prioritizing the execution of multiparametric Magnetic Resonance Imaging (mpMRI) in presence of suspicious PCa. Men with negative mpMRI and low clinical suspicion of PSA (PSA density < 0.20 ng/mL/cc, negative DRE findings, no family history) can be further monitored. Men with negative mpMRI and a higher risk of PCa (familial history, suspicious DRE, PSAD>0.20 ng/mL/cc or PSA>20 ng/mL) should be considered for systematic prostate biopsy. While PI-RADS 4-5 lesions represent a strong indication for prostate biopsy, PI-RADS 3 lesions should be further stratified according to PSAD values and prostate biopsy performed when PSAD is higher than 0.20. Accreditation, certification, and quality audits of radiologists and centers performing prostatic mpMRI should be strongly considered. The accessibility and/or the waiting list for MRI examinations should be also evaluated in the diagnostic pathway. The panel suggests performing transperineal or transrectal targeted plus systematic biopsies as standard of care.Scientific societies must support the use of shared diagnostic pathway with the aim to increase the early detection of significant PCa reducing a delayed diagnosis of advanced PCa. Moreover, a shared diagnostic pathway can reduce the incorrect use of antibiotic, the number of unnecessary laboratory and radiologic examinations as well as of prostate biopsies.