The advent of multiparametric magnetic resonance imaging (MRI) of the prostate changed the field of prostate biopsy. As in bore, biopsy during MRI is too expensive and complex, MR fusion biopsy gained widespread replacing traditional systematic biopsy. It can be performed as cognitive fusion or as software-based fusion in dedicated devices. Although the superiority of software-based fusion has not been proven in studies, the number of these procedures is raising. Several devices are on the market, enabling the urologist to process MR images, perform real-time TRUS, fuse both modalities using rigid or elastic fusion, perform fusion biopsy, and report it. There are no studies comparing these systems head-to-head, there is no consensus how technical accuracy and clinical performance should be measured. Software has been improved in performing steps semiautomated or automated and in reducing errors during image fusion. An advantage of software-based fusion is the possibility to include pathological information in three-dimensional reports and to use them for planning focal therapy. In the future, more automation of steps will save operating room time. The devices tend to get slim and lightweight with the possibility to perform both, transrectal and transperineal biopsies. Connectivity to therapeutic systems, for example for focal therapy, can be enhanced.