© 2017 Elsevier Inc. The introduction of widespread prostate-specific antigen screening brought about an increase in the detection of clinically low-risk prostate cancer. Many of these patients are overtreated by radical prostatectomy and radiation. Comparatively, focal therapy for prostate cancer offers the advantage of decreased rates of incontinence and impotence. The 12-core extended sextant transrectal ultrasound-guided needle biopsy is unable to safely identify candidates for focal therapy. Multiparametric magnetic resonance imaging (MRI) and MRI/ultrasound fusion-guided biopsy can detect more clinically significant prostate cancers and aid in accurate detection of higher-grade disease. MRI/ultrasound fusion-guided prostate biopsy is recommended as a modality of choice for selection of patients for focal therapy.