To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy. Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (+/- 95 % confidence intervals) were calculated and compared by Fisher's exact test. Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 +/- 0.08 vs 0.72 +/- 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 +/- 0.12 vs 0.28 +/- 0.10; p = 0.01) and GS 7-10 cancer (0.43 +/- 0.12 vs 0.2 3 +/- 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 +/- 0.11 for tertiary centre and 0.11 +/- 0.09 for initial reads; p = 1.00. Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions. aEuro cent Multiparametric MRIs were more often called negative in subspecialist reads (41 % vs 20 %). aEuro cent Second readings of prostate mpMRIs by subspecialist uroradiologists significantly improved NPV and PPV. aEuro cent Reporter experience may reduce overcalling and avoid overtargeting of lesions. aEuro cent Greater education and training of radiologists in prostate MRI interpretation is advised.