OBJECTIVE: To evaluate the cancer yield of transrectal prostate biopsies in a 3-T magnetic resonance imaging (MRI) scanner in patients with elevated prostate specific antigen (PSA) levels, recent negative transrectal ultrasonography (TRUS)-guided prostate biopsies PATIENTS AND METHODS: Between July 2004, November 2005, patients with at least one previous negative prostate biopsy within the previous 12 months had MRI-guided biopsy of the prostate in a 3-T MRI scanner Patients with previous positive biopsies for cancer were excluded Target selection was based on T2-weighted imaging, dynamic contrast-enhanced (DCE) imaging studies RESULTS: Thirteen patients were eligible; their median (range) age was 61 (47-74) years, PSA value 4 90 (1 3-12 3) ng/mL Most patients had one previous negative biopsy (range 1-4) Four patients had a family history of prostate cancer There were 37 distinct targets based on T2-weighted imaging Fifteen of 16 distinct DCE abnormalities were co-localized with a target based on T2-weighted imaging Despite this correlation, only one of 13 patients had a directed biopsy positive for cancer Including systematic biopsies, two of 13 patients had a biopsy positive for prostate cancer One patient had prostate intraepithelial neoplasia, one had atypical glands in the specimen CONCLUSION: The prostate-cancer yield of transrectal biopsies in a 3-T MRI scanner, among patients with recent negative TRUS-guided prostate biopsies, is similar to repeat systematic TRUS-guided biopsy DCE correlates with T2-imaging but does not appear to improve prostate cancer yield in this population