Objective To explore the clinical application value of multi-parameter magnetic resonance imaging-transrectal ultrasound (mpMRI-TRUS) cognitive fusion technology to guide targeted prostate biopsy. Methods The research objects were patients suspected of prostate cancer from January 2018 to December 2020 and the patients were divided into mpMRI-TRUS group and TRUS group. All cases in the mpMRI-TRUS group underwent mpMRI examination before needle biopsy. The targeted lesions were determined according to the MRI results.And mpMRI-TRUS cognitive fusion targeted biopsy and system 10-needle biopsy were performed. Patients in the TRUS group only underwent a systematic 13-needle biopsy. The detection rate of prostate cancer between the two groups was compared. At the same time, the difference in the detection rate of targeted biopsy and systematic biopsy in the mpMRI-TRUS group was also compared. The pathological results of puncture were observed and analyzed. Results The positive rate of needle biopsy in the mpMRI-TRUS group was 43.59%, and the TRUS group was 33.07%. There was no significant difference in the detection rate of prostate cancer between the two groups. In the mpMRI-TRUS group, the single-needle positive rate and the proportion of prostate cancer tissue were higher than that of system puncture. The positive rate of targeted puncture in the mpMRI-TRUS group was 38.46%, and the system puncture was 42.30%. The difference between the two groups is not statistically significant. Conclusion The mpMRI-TRUS cognitive fusion technology can detect prostate cancer with fewer needles in prostate biopsy. Targeted biopsy puncture can provide more prostate cancer tumor tissues and reduce the missed diagnosis rate of prostate cancer biopsy.