The role of multiparametric MRI (mpMRI) in the management of prostate cancer is undergoing significant change. While it continues to play a (limited) role in assessing local disease spread, it is increasingly being used to detect aggressive cancer foci prior to biopsy. In patients with a history of a negative biopsy and persistent suspicion of prostate cancer, the literature clearly shows an increase in the detection rate of aggressive cancers when targeted biopsies are added to systematic biopsies. Consequently, most professional societies recommend performing an MP-MRI before repeat biopsy. The added value of mpMRI is less clear in the population of patients referred for an initial biopsy series, but several multicenter controlled studies are underway to quantify its benefit. It makes sense to offer mpMRI at the start of active surveillance to detect aggressive cancer that may have been missed by the initial biopsies, and most recommendations support this approach. Data are still lacking to clarify the role of mpMRI during the course of active surveillance. For now, most professional societies do not recommend foregoing routine biopsies when mpMRI is negative. This last point remains controversial and complex, as the negative predictive value of mpMRI depends on the prevalence of cancer. Each target population must therefore be carefully studied to determine whether or not mpMRI can avoid unnecessary biopsies.