Abstract: Prostate cancer is one of the most common malignant tumors in men, with rapidly increasing incidence and mortality rates. Currently, the advisability of performing prostate biopsy for men with PI-RADS scores of 1-3 is controversial. Aggressive biopsy may lead to over diagnosis, increasing patient suffering, whereas active surveillance may increase late diagnosis and disease progression. Accurately identifying cases that merit prostate biopsy is an important challenge in clinical practice. Recently, numerous studies have explored whether individuals with PI-RADS scores of 1-3 should undergo prostate biopsy, but this recent research has not yet been systematically summarized and discussed. In this article, we summarize predictive factors indicating prostate biopsy in the PI-RADS 1-3 population and discuss their predictive value to provide new guidance for clinical practice and further research.