Multiparametric MRI (mpMRI) has been shown to improve the detection and localization of prostate cancer as well as the discrimination of benign findings (like prostatitis or BPH) and is therefore ideally suited for targeting as well. While biopsy guidance in an MRI system typically requires more efforts and time (30‑120 min) [1] than under ultrasound imaging, MRI provides unparalleled contrast of prostate substructures and biopsy needle. Diagnostic detection rates show large variability between patient groups and sites but are widely acceptable (e.g., 8‑59%, median 43% [1]). A custom-made navigation option for a commercial device allows us to use any intraprocedural MRI data for stereotactic real-time biopsy targeting. The purpose of this work is to report on the navigation features, indications and clinical biopsy results for a total of 75 patients. Seventy patients (52-80 years old, mean 65) with mean PSA level 12.0 (1.8–60) ng/mL and after 0 to 9 (mean 1.8) negative transrectal ultrasound-guided biopsies underwent MRI biopsy of the prostate at 3 T (Magnetom Tim Trio, Siemens). Navigation was used under IRB approval and with written informed consent. The passive interventional device (DynaTRIM, Invivo, Gainesville, FL) features two translational and two rotational degrees of freedom (DOF) and uses an MRI-visible needle guide for transrectal access to the prostate. Optical and MRI reference markers were added to the setup (Fig. 1) to accurately register and track the needle guide (6 DOF). Procedural planning and control was operated from a dedicated navigation PC (Localite GmbH, St. Augustin, Germany, Fig. 2). Histopathological biopsy results (Gleason Score GS), intervention times (from first T2W planning to final T2W control series) and complications were documented.Stereotactic navigation was used for 61 patients (81.3%). Marker-based registration was successful in all cases and typically required an extra 0.5-3 min. The additional in-room hardware did not impair MR image quality or patient comfort. The operating radiologists considered the real-time feedback about the virtual needle direction to be helpful for procedural guidance, in particular for less accessible regions like the apex, lateral mid gland and basis of the prostate (Fig. 3). Mean intervention time (Fig. 4) for 75 patients was 59 min (26-124 min, median 57 min) and included 23 patients where two lesions were targeted (mean time 66 min). Two patients (2.7%) developed a major complication (urosepsis) and were successfully treated with intravenous antibiotics. The obtained biopsy specimens were diagnostic in all cases. Histopathology findings were positive in 43 of 75 patients (57.3%) and 46 of 98 targeted lesions (46.9%) and included 43 prostate cancers (27× GS=3+3, 13× 3+4, 2× 4+3 and 1× 4+4), one high-grade prostatic intraepithelial neoplasia (HG-PIN) and two atypical small acinar proliferations (ASAP). The custom-made navigation option integrated seamlessly into the clinical workflow for MRI-guided prostate interventions. Our procedures, mainly navigated, are still rather time consuming but also revealed a relatively high number of prostate cancers. The real-time navigation scene was found to improve orientation and control, in particular for less accessible locations in the prostate.