Currently, there is no consensus with respect to the optimal platform or approach for performing targeted prostate biopsies. Whereas many investigators have previously compared transperineal (TP) and transrectal (TR) approaches across a variety of biopsy indications, this is the first study to compare TP and TR targeted biopsies using the same fusion biopsy platform (UroNav, Philips Healthcare) and mpMRI protocol. These technical consistencies reduce variability in image registration error, biopsy tracking, and MRI interpretation between the groups in order to minimize potential confounding and strengthen the ability to make fair comparisons between the approaches.