Six systematic reviews and three randomized controlled trials examining the clinical evidence of MRI prior to TRUS guided prostate biopsy for the diagnosis of prostate cancer were included in this review. There was no evidence that there was a significant difference in overall prostate cancer detection rate between a diagnostic strategy employing magnetic resonance imaging (MRI) followed by targeted transrectal US-guided (TRUS-guided) biopsy and a diagnostic strategy consisting of TRUS-guided biopsy alone. MRI-US fusion targeted TRUS-guided biopsy was had higher detection rates of patients with clinically significant prostate cancer versus standard TRUS-guided biopsy. Lower detection rates of patients with clinically insignificant prostate cancer were found for MRI-US fusion targeted TRUS-guided biopsy versus standard TRUS-guided biopsy, but not in patients undergoing repeat prostate biopsy. No clinical benefits were found for cognitive targeted TRUS-guided biopsy over standard TRUS-guided biopsy.Four economic evaluations, which included one Canadian study, and two health technology assessments with economic evaluations were included in this review and the results suggested that including MRI before TRUS-guided biopsy was more cost-effective than standard TRUS-guided biopsy alone. MRI-US fusion targeted TRUS-guided biopsy was cost-effective in initial biopsy and repeat biopsy patients and cognitive targeted TRUS-guided biopsy was cost-effective in initial biopsy patients. The evidence for clinical effectiveness was limited by the lack of reporting of long-term outcomes and safety outcomes, the varying quality of the systematic reviews, the heterogeneity in study characteristics, and the limited number of randomized studies. These limitations hampered the economic evaluations as the clinical inputs relied on assumptions regarding the accuracy of the diagnostic strategies and the long-term consequences of misdiagnosing patients.