MRI Guided Prostate Biopsy

This study compares two methods of guiding prostate biopsy — one using MRI imaging combined with live ultrasound (MRI-fusion biopsy), and another where the doctor uses their memory and judgment from reviewing the MRI beforehand (cognitive biopsy). The goal is to see which method more accurately detects clinically significant prostate cancer. **You may be eligible if...** - You are over 30 years old - You have a prostate-specific antigen (PSA) level above 4 ng/mL or a nodule found on rectal exam - Your MRI shows a suspicious prostate lesion - You have signed informed consent - You have no contraindications to MRI (no pacemaker or implants incompatible with MRI) **You may NOT be eligible if...** - You cannot give informed consent - You have a pacemaker, inner ear implants, or other MRI-incompatible devices - You have active heart disease such as ongoing angina Talk to your doctor to see if this trial is right for you.