Introduction: Multiparametric magnetic resonance imaging (mpMRI) is a non-invasive diagnostic modality for characterization of prostate lesions and for detection of clinically significant prostate cancer. High negative predictive value recently included this method in the diagnostic algorithm before the prostate biopsy. Recommendations after negative mpMRI, defined as Prostate Imaging Reporting and Data System (PI-RADS) 1 or 2, depending on other clinical risk factors allow shared decision-making with the patient to omit biopsy. Aim: The aim of this study was to investigate feasibility and safety of follow-up in men with clinical suspicion of prostate cancer and negative mpMRI, without prostate biopsy, and to correlate clinical and mpMRI parameters between the followed group of biopsy-naΓ―ve men (BN) and the group of men after a negative prostate biopsy (nBx). Material and Methods: This prospective-retrospective study included men with negative mpMRI and urology referral with clinical suspicion of prostate cancer. The biopsy-naΓ―vegroup was followed clinically and with mpMRI, without prostate biopsy unless clinical or mpMRI progression. Minimal follow-up period was two years, with minimal two mpMRI controls. Control group consisted of men after a negative prostate biopsy. Multiparametric MRI and clinical parameters were correlated between groups. Results:The final analysis included 118 men. No significant difference in apparent diffusion coefficient (ADC) between BN and nBx group was registered (p=0.527). There was no significant difference in prostate-specific antigen (PSA) density (p=0.147) or PSA index (p=0.313) between groups, while total serum PSA level was significantly lower in BN group (p=0.004). BN men were followed between 2 and 13 years (mean 8 years). No prostate biopsy was performed or clinically significant prostate cancer was diagnosed during the follow-up period. Conclusion: In men with clinical suspicion of prostate cancer and negative mpMRI, ADC values, PSA density and PSA index are not significantly different between BN and nBx groups, whilst serum PSA level is lower in BN group. Long-term follow-up without a biopsy is feasible and safe in a clinical setting, without a diagnosis of clinically significant cancer during the mean period of eight years.