Prostate cancer is the most frequent malignant diagnosis in men. Systematic biopsy with transrectal gray scale ultrasound guidance is the main method of detection in patients with elevated serum PSA and/or abnormal digital rectal examination. As this method may miss approximately 35% of cancers several methods for improving detection rates have evolved. These include 3D ultrasound, Doppler ultrasonography, contrast enhanced Doppler ultrasonography, elastography, intermittent harmonic imaging, magnetic resonance imaging and 3D magnetic resonance spectroscopy. Decreasing the number of biopsied cores and increasing the accuracy at diagnosis are the two main goals of using these technologically improved machines. Although these are encouraging adjuncts to better cancer detection, targeted biopsy protocols are still far from replacing systematic biopsies in routine practice.