Transrectal ultrasonography has widely been used for evaluating the prostate and guiding biopsy: nevertheless, it has been shown that transrectal ultrasonography has limited value for detecting prostate cancer (PCa) owing to its unsatisfactory sensitivity and variable accuracy. Contrast-enhanced transrectal ultrasonography that can enhance the visualization of perfusion changes related to prostate cancer is regarded as a promising tool for improving the detection of prostate cancer. It has the potential to perform lesion-targeted biopsy that may ultimately improve the detection of prostate cancer. Several studies have shown that contrast-enhanced transrectal ultrasound-guided biopsies may have a significantly higher positive per core detection rate (DR) and significantly higher mean Gleason score cancer detection rate compared with systematic biopsy. Nevertheless, future randomized clinical trials are necessary to confirm the value of contrast-enhanced-targeted transrectal ultrasound-guided biopsy in regular clinical practice.