The primary aim of this study was to determine the clinically significant cancer detection rate (csCDR) of Transperienal (TP) targeted biopsies using robotic-assisted (RA) MRI ultrasound fusion biopsy (MFB) compared to cognitive targeted biopsies (C-TB) using a grid template as this has not previously been reported. Secondary aims were to determine differences in complications between the two methods. Robot Assisted targeted biopsy using Mona Lisa results in higher CDR for clinically significant cancers and any cancer. It also suffers lower complications compared to cognitive directed TP biopsy.