The management of prostate cancer (PCa) continues to evolve and does so at a rapid rate. Research and technological developments continue to refine our definitions and management of this complex disease. As we acquire a greater understanding of the natural history of PCa and its biology, the prevention of overtreatment has shaped a new era with the move from more radical treatments to the adoption of active surveillance (AS) and advancement of focal therapy (FT). An important factor in this move to less invasive therapies is the expanded role that multiparametric magnetic resonance imaging (mpMRI) is playing in the detection and characterization of clinically significant prostate cancer. We are now able to locate and monitor cancers more effectively than ever before with the inclusion of functional imaging sequences such as diffusion weighted imaging and dynamic contrast enhanced imaging. These capabilities combined with promising results from current prospective studies have changed the face of FT. Our presentation will focus on how to utilize mpMRI-assigned targets for image-guided biopsy and therapy in our move to a more personalized approach to the patient with PCa.