The optimal strategy for prostate cancer diagnosis is to avoid overdiagnosis, defined as diagnosis of clinically insignificant disease, and undersampling of the gland, which leads to missing clinically significant disease. Targeted prostate biopsy is a potential solution for decreasing the rate of both overdiagnosis and undersampling of prostate cancer. We focus here on different techniques for targeting prostate lesions identified on multiparametric MR imaging and review different clinical settings in which MR imaging–targeted prostate biopsies are performed.