Objective To estimate the value of multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies (TB) in the biopsy naive patients.Methods From June 2016 to December 2017,178 patients with suspicious prostate cancer were retrospectively evaluated.The age of patients was 54-87 years(median 70 yesrs).Serum PSA level before biopsy was 1.5-95.0 ng/ml (median 13.2 ng/ml),in which 70 cases with PSA ＜ 10 ng/ml,58 cases 10-20 ng/ml,and 50 cases ＞ 20 ng/ml.All patients underwent transrectal ultrasound (TRUS),real-time tissue elastography (RTE) and contrast-enhanced ultrasonography(CEUS).All positive sites on imaging undergoing two-core TB and 10 core-systematic biopsy (SB).The detection rates and positive rates of biopsy for any cancer (PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB.Pathological findings of each biopsy core was analyzed for Gleason grade and the single-core length of prostate cancer.Results The total detection rate for PCa was 48.8％ (87/178).The diagnostic accuracy of PCa did not significantly differ between TB 35.5％ (63/178) and SB 42.8％ (76/178) groups.There was no significant difference between the proportion of CsPCa in TB group and SB group [80％ (50/63) vs.66％ (50/76),P =0.21].TB had an obvious higher single-core positive rate for prostate cancer 60.6％ (449/740) and an obvious higher singlecore positive rate for high-risk prostate cancer [10.3％ (76/740)] than SB [29.7％ (530/1 780) and 5.5 ％ (98/1 780)],with statistically signficant difference (P ＜ 0.001,P =0.002).TB also had a higher single-core length of prostate cancer than SB [6.80 (0.20-15.00) mm vs.5.50 (0.06-18.00) mm,P ＜0.05].Conclusions This study revealed a similar rate of prostate cancer detection between multi-modal guiding in transrectal ultrasound-guided prostate targeted biopsies (TB) and 10 core-systematic biopsy (SB).TB maybe tend to detect higher proportion of high-risk PCa.