Objective: To share our clinical experience with cognitive prostate biopsy and compare results of cognitive biopsies with standard biopsies. Materials and Methods: The data of patients for whom prostate biopsy was performed at Marmara University Faculty of Medicine, Department of Urology in 2020 were retrospectively reviewed. All biopsies, including repeat biopsies are included in the study. Basic clinical characteristics and pathological outcomes were compared between the groups. Clinically significant prostate cancer (PCa) was defined as gleason grade group 2 or more in biopsy pathology. Results: The mean age of all patients included in the study was 64.9±8.16 years. Median prostate specific antigen (PSA) level was 7.7 (5.0-12.8) ng/dL. There were no statistically significant differences between the two groups with respect to patient age, total and free PSA values, digital rectal examination and radiologic prostate volume. Biopsy pathologies were also similar between the groups. Our data demonstrated that patients with advanced age and higher levels of total PSA value were more likely to have clinically significant PCa. The positive predictive value of digital rectal exam (DRE) was 43.5% for clinically significant cancers and 59.0% for all PCa, which was higher than Prostate Imaging-Reporting and Data System 4 and 5 lesions. Conclusion: Clinical experience could be the main determining factor in cognitive fusion biopsy results. Our results show that cognitive biopsy is not superior than standard systematic biopsy. So taking standard biopsy core should not be neglected, especially in inexperienced clinics. Our results also support the fact that DRE is still one of the most cost-effective diagnostic tools for clinically significant PCa.