Conventional systematic core biopsies might fail to detect clinical significant prostate cancer. ARTEMIS MRI-ultrasound fusion guided prostate biopsy (ART-PBx) might overcome this issue by improving the targeting of suspicious lesions. In a retrospective clinical study including 194 patients (243 lesions) we determined a target performance of 56.3 % positive biopsies related to histopathology. The detection rate rises up to 71.4% for high score lesions (PIRADS 5) but did not show any correlation with lesion’s size. This target methodology based on MRI achieves greater detection rate of clinical significant prostate cancer, improving the ability to appropriately counsel patients regarding therapy.