To study the staging accuracy of multiparametric magnetic resonance imaging (MRI) in patients showing unilateral low-risk cancer on prostate biopsy. A total of 58 consecutive patients with low-risk cancer (D'Amico classification) and unilateral cancer involvement on prostate biopsies were included prospectively. All patients underwent multiparametric endorectal MRI before radical prostatectomy, including T2-weighted (T2W), diffusion-weighted (DW) and dynamic contrast enhanced (DCE) sequences. Each gland was divided in eight octants. Tumor foci >0.2 cm(3) identified on pathological analysis were matched with MRI findings. Pathological examination showed tumor foci >0.2 cm(3) in 50/58 glands (86%), and bilateral tumor (pathological stagepT2c) in 20/58 (34%). For tumor detection in the peripheral zone (PZ), T2W+DWI+DCE performed significantly better than T2W+DWI and T2W alone (P<0.001). In the transition zone (TZ), only T2W+DWI performed better than T2W alone (P=0.02). With optimal MR combinations, tumor size was correctly estimated in 77% of tumor foci involving more than one octant. Bilateral tumors were detected in 80% (16/20) of cases. In patients with unilateral low-risk prostate cancer on biopsy, multiparametric MRI can help to predict bilateral involvement. Multiparametric MRI may therefore have a prognostic value and help to determine optimal treatment in such patients.