AIMTo determine whether biparametric MRI is effective in the diagnosis of clinically significant prostate cancer in prostate peripheral zone PIRADS 3 lesions without the use of dynamic contrast enhancement. MATERIALS AND METHODSPatients who underwent biparametric MRI over a 12-month period from January 2022 to December 2022 and were diagnosed with PIRADS 3 lesion in the peripheral zone were included in the study. No patient received dynamic contrast enhancement. Histological analysis was done after performing local anaesthetic transperineal biopsy to determine detection rate of clinically significant prostate cancer. Prostate specific antigen density (PSAD) and biopsy complication rates were also reviewed. RESULTS61 out of 688 MRIs (8.8%) performed over the study period had a PIRADS 3 lesion in the peripheral zone where contrast is supposed to add value. 58/61 went ahead to biopsy and csPCa (Gleason ≥ 3 + 4 with a max core length of ≥6mm, and above) was diagnosed in 17%. Among those diagnosed with csPCa, 80% had PSAD of more than 0.15 ng/ml/cc. No post-biopsy complications were reported. CONCLUSIONBiparametric MRI without contrast offers a reliable alternative to multiparametric MRI with minimum or neglible impact on csPCa diagnosis in peripheral zone PIRADS 3 lesions, especially when used in conjunction with other factors such as PSAD. There is potential to address health economics and patient burden in prostate cancer investigation.