Purpose <p>This study aimed to evaluate whether a prior transurethral resection of the prostate (TURP) influences multiparametric magnetic resonance imaging (mpMRI) findings or biopsy-derived tumor grade in patients diagnosed with prostate cancer.</p> Methods <p>This retrospective study included 180 patients diagnosed with prostate cancer between June 2021 and July 2024. Sixty patients with a history of benign TURP formed the study group, while 120 patients without previous TURP served as controls. Age, pre-biopsy PSA, prostate volume, PSA density (PSAD), mpMRI PI-RADS v2.1 score, and ISUP grade were compared between groups. In the TURP cohort, the interval between TURP and biopsy and the resection ratio were analyzed according to ISUP 1 versus ISUP ≥ 2 categories. Receiver Operating Characteristic (ROC) analysis was used to assess the predictive ability of these variables for clinically significant prostate cancer (csPCa; ISUP ≥ 2).</p> Results <p>The two groups did not differ significantly in age, prostate volume, PSA, or PSAD (all <i>p</i> &gt; 0.05). PI-RADS and ISUP distributions were also comparable (<i>p</i> = 0.068 and <i>p</i> = 0.950). The csPCa rate was 60% in the TURP group and 61.7% in controls (<i>p</i> = 0.872). Among TURP patients, neither the TURP–biopsy interval (5.50 ± 2.17 vs. 5.36 ± 2.28 years; <i>p</i> = 0.760) nor the resection ratio (0.323 ± 0.053 vs. 0.334 ± 0.090; <i>p</i> = 0.780) differed between ISUP categories. ROC analysis showed no predictive value for csPCa (AUC 0.477 and 0.515, respectively).</p> Conclusion <p>Prior TURP did not affect mpMRI findings, tumor grade, or the likelihood of csPCa. The TURP–biopsy interval and resection ratio were not predictive of csPCa, supporting that TURP does not alter subsequent prostate cancer diagnostic or pathological outcomes.</p>