BACKGROUND AND OBJECTIVE: Traditionally, patients with positive magnetic resonance imaging (MRI) results [i.e., Prostate Imaging-Reporting and Data System (PI-RADS) ≥3] would have to undergo both targeted and systematic biopsies. The 2024 European Urology Association guidelines now recommend incorporating perilesional sampling with targeted biopsy; however, these recommendations have not yet been widely adopted. This review aims to examine recent advancements in personalized prostate biopsy techniques to enhance cancer detection through tailored approaches. METHODS: We conducted a narrative review to highlight recent advancements in personalized prostate biopsy techniques, emphasizing the roles of serum prostate-specific antigen (PSA) levels, prostate volume (PV), PSA density (PSAD), region of interest (ROI), and PI-RADS scores. KEY CONTENT AND FINDINGS: This review discusses personalized prostate biopsy protocols, integrating PSA levels, PV, PSAD, and PI-RADS scores. Tumor localization can be refined using transrectal or transperineal approaches. For patients with lower PSA levels (4-19.99 ng/mL), smaller PSAD (<0.1 ng/mL/cc), or PI-RADS 3 lesions, a targeted plus systematic biopsy or regional saturation biopsy may be appropriate. For those with medium PSA levels (20-50 ng/mL), PSAD (0.1-0.2 ng/mL/cc), or PI-RADS 4 lesions, regional saturation biopsy is preferred. Targeted biopsy is recommended for higher PSA levels (>50 ng/mL), PSAD (>0.2 ng/mL/cc), or PI-RADS 5 lesions. Variability in cut-off values across studies precludes meta-analysis, limiting our work to a systematic review. CONCLUSIONS: Personalized prostate biopsy protocols considering PSA levels, PV, PSAD, ROI, and PI-RADS scores can improve prostate cancer detection accuracy. Further research and clinical validation are needed to optimize these personalized methods.