The study aims to conduct a diagnostic test accuracy systematic review and meta-analysis to compare the abbreviated biparametric MRI (bpMRI; T2-weighted imaging (T2WI) and DWI) and multiparametric MRI (mpMRI; T2WI, DWI and dynamic contrast-enhanced (DCE) MRI) for the detection of clinically significant prostate cancer (csPCa) in treatment-naïve patients.Two independent reviewers performed a systematic search of electronic databases (PubMed, Web of Science, Embase, Cochrane library, and ClinicalTrials.gov) from January, 2012 to July, 2025 using predefined search criteria. The index test was bpMRI and/or mpMRI, and the reference standard was histopathological findings from prostate biopsy or radical prostatectomy. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool was used to assess the risk of bias of included articles, AMSTAR-2 (Assessing the methodological quality of systematic reviews) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) working group classification were employed to assess the study quality. The sensitivity and specificity were pooled by bivariate random-effects model and graphically presented with summary ROC (SROC) curves. Multiple subgroup analyses of possible covariates were employed to explore potential heterogeneity.A total of twenty-five studies were included in our review. For bpMRI, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) was 0.87 (95%CI, 0.83-0.92), 0.67 (95%CI, 0.59-0.76), 2.7 (95%CI, 2.1-3.4), 0.19 (95%CI, 0.14-0.24), 14 (95%CI, 10-21) respectively. For mpMRI, the pooled sensitivity, specificity, PLR, NLR, DOR was 0.89 (95%CI, 0.86-0.93), 0.66 (95%CI, 0.57-0.75), 2.6 (95%CI, 2.1-3.3), 0.16 (95%CI, 0.11-0.22), 17 (95%CI, 11-25). The AUC value of SROC curve was 0.88 (95%CI, 0.83-0.89), 0.87 (95%CI, 0.84-0.89) for bpMRI and mpMRI. Meta-regression showed that mpMRI achieved significantly higher sensitivity than bpMRI, while the two modalities demonstrated comparable specificity.This systematic review and meta-analysis suggested that mpMRI offered significantly higher sensitivity while maintaining equivalent specificity for csPCa detection compared to bpMRI. Whether adopting bpMRI as a substitute for mpMRI remains an issue and warrants careful consideration. More prospective multicenter, comparative studies are warranted to validate our results.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.