OBECTIVES: To examine magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion biopsies completed within Manitoba and evaluate their ability in detecting clinically significant prostate cancer. PATIENTS & METHODS: 200 cases from October 2021 and May 2022 that met the inclusion criteria were reviewed. Clinical and pathologic information was collected for each case. The cancer detection rate (CDR) and clinically significant CDR were calculated for systematic and targeted prostate biopsy cores for patients that underwent MRIs at Health Sciences Centre (HSC) or St. Boniface General Hospital (SBGH). Clinically significant prostate cancer was set as all cancers with a Gleason score ≥4+3/Grade Group ≥3 or Gleason score 3+4/Grade Group 2 with cribriform and/or intraductal carcinoma present. RESULTS: The overall CDR including both systematic and targeted biopsy cores was determined to be 75.0%, with an overall CDR for targeted biopsies of 70.5%. The targeted biopsy cores had an overall clinically significant CDR of 34.0%. Prostate cancer was detected in only the targeted biopsies in 38 of the 200 cases, with clinically significant prostate cancer detected in 12 of those cases compared to 9 cases that detected cancer in the systematic biopsies only, 3 of which were clinically significant. When stratified by MRI site, SBGH had a higher targeted biopsy CDR (76.1%) and clinically significant targeted biopsy CDR (35.1%) compared to HSC (59.1% and 31.8%). Nine of the 18 radical prostatectomies had no cancer detected in the systematic biopsies. CONCLUSIONS: This study has established that MRI-TRUS fusion biopsies are effective in detecting additional clinically significant prostate adenocarcinomas in Manitoba.