OBJECTIVES: Prostate cancer diagnosis is undergoing a significant change in recent years. The concern about prostate cancer overtreatment as well as technological developments that allow for better visuali-zation of prostate cancer lesions are the main drivers for this change.METHODS: This was a narrative review of the literature on prostate cancer diagnosis.RESULTS: The diagnostic pathway of prostate cancer based on PSA screening and systematic TRUS has re-mained unaltered for many years. This is not free of error and many men with insignificant prostate cancer will be diagnosed. Secondly, men with significant prostate cancer will be missed. Moreover, TRUS approach is associated with a non-negligible rate of sepsis. With the introduction of prostate multiparametric MRI, it seems that we are moving towards a less invasive method of triaging men for prostate biopsy and adopting a biopsy technique which aims to target specific areas within the prostate rather than randomly sampling it. There are a number of other imaging modalities that have attrac-ted attention such as Elastography, histoscanning and contrast enhanced ultrasound. A targeted-only biopsy approach is a feasible option for prostate cancer diag-nosis that can improve significant cancer detection and reduce insignificant cancer detection when compared to TRUS biopsy.CONCLUSION: The introduction of multiparametric prostate MRI has the potential to change the way that we diagnose men with prostate cancer.