OBJECTIVE: The study aimed at investigating the value of systemic biopsy (sysPbx), magnetic resonance imaging/ultrasound fusion targeted biopsy (fusPbx) and fusPbx combined with sysPbx (comPbx) for prostate cancer (PCa) detection. MATERIALS AND METHODS: Data from the PubMed, Cochrane, and Embase databases were searched from inception until March 23, 2020. Prospective studies comparing the detection rates of sysPbx, fusPbx and comPbx were identified. We pooled the detection rates for all PCa, clinically significant prostate cancer (csP-Ca), and clinically insignificant prostate cancer (cinsPCa) of fusPbx, sysPbx, and comPbx. Risk ratios (RRs) were calculated for the meta-analysis. Then, analyses were performed to identify the possible sources of heterogeneity. RESULTS: Seventeen studies, including 18 cohorts with 3035 men, were included. No patients had previous evidence of PCa. Each patient had one or more suspicious lesions found on multiparametric magnetic resonance imaging (mpMRl) and received both fusPbx and sysPbx. The results showed that fusPbx and sysPbx did not differ significantly in detecting all PCa (RR=1.00, 95% CI: 0.95-1.05, p>0.05). However, fusPbx provided a higher detection rate for csPCa (RR=1.24, 95% CI: 1.14-1.34, p<0.05) and a lower detection rate for cinsPCa (RR=0.68, 95% CI: 0.61-0.76, p<0.05) than sysPbx. In addition, comPbx detected more PCa (RR=1.22, 95% CI: 1.16-1.29, p<0.05) and csPCa cases (RR=1.13, 95% CI: 1.05-1.21, p<0.05) than fusPbx. CONCLUSIONS: In men with positive mpMRl findings, compared to sysPbx, fusPbx had significantly increased the detection rates for csPCa and decreased those for cinsPCa. The combination of fusPbx with sysPbx outperformed fusPbx in detecting both overall PCa and csP-Ca.