Heterogeneity and clinical insignificance of prostate cancer (PCa) lesions challenges diagnosis and management. Introduction of the multi-parameter (mp)-MRI/ultrasound fusion-guided biopsy increased detection of clinically significant cancer. Prostate MRI lesions receive a PI-RADS score based on likelihood of being cancer-positive. Fusing MRI images with live ultrasound guides biopsy from the targeted area. Previously, PI-RADS score has been correlated with clinical significance of cancer and morphological variations in PCa lesions. We studied PI-RADS score according to tissue MRS-based metabolomics. Metabolic differences between Target and Non-target cores, regardless if Targets were cancer-positive, support the assumption that targeted areas fundamentally differ from non-targeted areas.