Objective · To evaluate population anterior horn biopsy in the diagnosis of prostate cancer. Methods · The clinical and pathological data of 1 679 patients who underwent ultrasound-guided initial 12-core prostate biopsies at Renji Hospital, Shanghai Jiao Tong University School of Medicine, were retrospectively analyzed. The performances of 12-core (including anterior horn) biopsy and the 10-core (except anterior horn) biopsy were compared in total population and different subgroups for the detection rates of prostate cancer. Results · Of the 1 679 patients, 678 (40.4%) were diagnosed with prostate cancer, and 59 (8.7%) were only positive at anterior horns. After excluding the anterior horn biopsy, the detection rate was 36.9% (619/1 679), which was lower than the overall detection rate including the anterior horn biopsy (40.4% vs 36.9%, P0.046). In prostate specific antigen (PSA) and prostate volume subgroups, for the patients with PSA>10 ng/mL and prostate volume ≥30 mL, the biopsy detection rate was improvedadding the anterior horn biopsy (P<0.05). The patients with only positive anterior horn biopsy had higher prostate volumes and lower Gleason scores, compared with the patients with positive biopasy excluding anterior horn (P0.006, P0.000). Conclusion · Adding the anterior horn biopsy could improve the prostate cancer detection rate, recommended to be routinely used in the initial prostate biopsies.