BEST OF 2019: Edited by Johannes W. Vieweg and Shahrokh F. ShariatDevelopments in MRI-targeted prostate biopsyNorris, Joseph M.a,b,c; Kinnaird, Adamd; Margolis, Daniel J.e; Padhani, Anwar R.f; Walz, Jocheng; Kasivisvanathan, Veerua,b,c,hAuthor Information aUCL Division of Surgery and Interventional Science, University College London bLondon Deanery of Urology cDepartment of Urology, University College London Hospitals NHS Foundation Trust, London, UK dDepartment of Urology, University of California, Los Angeles, Los Angeles eDepartment of Radiology, Weill-Cornell Medical College, New York, USA fPaul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK gDepartment of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France hDepartment of Urology, Frimley Health NHS Foundation Trust, London, UK Correspondence to Joseph M. Norris, BSc (Hons), MSc, BM BS, MRCS (Eng), MRC Clinical Research Training Fellow, University College London, UCL Division of Surgery & Interventional Science, 3rd Floor, Charles Bell House, London W1W 7TS, UK. Tel: +44 7724022171; e-mail: email@example.com Current Opinion in Urology: January 2020 - Volume 30 - Issue 1 - p 1-8 doi: 10.1097/MOU.0000000000000683 Buy Metrics Abstract Purpose of review MRI-targeted prostate biopsy may be an attractive alternative to systematic biopsy for diagnosing clinically significant prostate cancer. In this narrative review, we discuss the new developments that have occurred in the advancement of MRI-targeted prostate biopsy, over the past 24 months. Recent findings MRI-targeted biopsy offers enhanced diagnostic accuracy, when compared with the current standard of care of systematic transrectal ultrasound-guided (TRUS) biopsy, by decreasing the overall number of biopsies needed, maintaining or improving significant prostate cancer detection, and reducing the detection of clinically insignificant prostate cancer. The necessity of combining systematic prostate biopsy with MRI-targeted biopsy is still debated. The use of MRI--ultrasound fusion systems for lesion-targeting is promising for optimizing significant cancer detection, but recent evidence suggests that additional cognitive biopsy cores are still useful in detecting additional cancers. Summary MRI-targeted biopsy in selected men with positive MRI offers a number of benefits over systematic biopsy in all men, and as such, may emerge as the new standard of care for the diagnosis of clinically significant prostate cancer. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.