Aim: The comparison of diagnostic accuracy for prostate cancer detection between elastography plus MRI image based TRUS biopsy versus extended core biopsy. Methods: This Comparative study was carried out in the Department of Radio Diagnosis, Katihar Medical College, Katihar (Al-Karim University), Bihar, India for 1 year. 50 Patients withage group of 35 to 75 years, with Serum PSA greater than 4.0 ng/dl were included in this study. All patient underwent TRUS biopsy based on the MRI and elastography images, followed by TRUS guided extended core biopsy (13 cores) done by radiologist randomly. The rate of prostate cancer detection was compared between the two types of biopsies. Group A consisted of cores from MRI plus Elastography guided TRUS biopsy and Group B were cores from Extended core biopsy. Both group werecompared. Results: The mean age of patients was 63.71. Themean serum PSA for patients was 14.77 ng/dl (6.5 to 40.7). 20 cases presented with AUR and patients were catheterized. The mean size of prostate in all 50patients was 51.77 mg (29 to 84 mg). The mean size of prostate and serum PSA of patients with carcinoma prostate were 14.9 mg and 18 ng/dl respectively . Prostatic carcinoma detection with extended core biopsy was 42% (n=21). The incidence of prostate cancer detection by MRI plus Elastography guided TRUS is 41 cases (82%). MRI plus Elastography guided TRUS biopsy method is considered tobe statistically significant as the p value is 0.0369(since p < 0.05) as obtained by fishers exact test. In our study majority of the patients had adenomatous hyperplasia (n=30,60%) as the HPE diagnosis , followed by adenocarcinoma (n==20,40%). The sensitivity of mpMRI plus Elastography image based TRUS biopsy method in detecting Prostate cancer was 84.5% and specificity was 82 % . The positive predictive value of thismethod wasfound to be 80%. Conclusion: Although mpMRI and Elastography are individually useful for detection of prostate malignancy, combining both the diagnostictoolsfor TRUS guided increases the rate of cancer detection than that of extended core biopsy.