This prospective clinical trial evaluates whether HM-MRI identifies PCa more reliably than random biopsy and/or targets detected based on PI-RADSv2. Patients underwent 3T mpMRI along with HM-MRI. Patients received 12-core TRUS-guided sextant random biopsy. Additional biopsy targets selected by radiologist (≥PI-RADS 3) and suspected PCa based on HM-MRI tissue composition estimates were biopsied, using a Uronav MR-US fusion biopsy device. The diagnostic accuracy of HM-MRI for detecting clinically significant cancers was higher than that of mpMRI on per-tumor (0.74 vs 0.61) and sextant analysis (0.84 vs 0.75). HM-MRI had higher accuracy, sensitivity, specificity and PPV than mpMRI, with similar NPV.