Prostate biopsy prior to radical treatment for prostate cancer is a common practice worldwide to allow diagnosis, prognostication, and treatment planning. However, recent advances in prostate multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) have made the possibility of a "biopsy-free" radical prostatectomy, without prior biopsy, closer to reality than before. The biopsy-free approach serves to avoid investigation-related morbidity, health care resources, and time to definitive treatment, but is not without risk. Here we review the literature surrounding the rationale, limitations, and current data.