TRUS biopsy known to have low cancer detection rates in patients with large prostate volumes. With the proved advantages of MRI guided biopsy (MRGB), it may offer a better alternative to those patients. We compared between cancer detection rates of TRUS biopsy and MRGB in 49 patients as related to their prostate volumes. MRGB showed better detection of clinically significant cancers in prostate volumes between 30-59 mL . Adopting MRGB in patients with gland volumes ≥ 30 mL may save patients the need for repeated TRUS biopsies, provide better disease risk stratification, and reduce the healthcare costs associated with unnecessary biopsies.