Background: Although gray-scale Trans Rectal Ultrasonography (TRUS) was a major achievement in diagnosis of prostate cancer, it has several limitations. Expert users are not able to discriminate among images with more than 32 gray levels out of 256 displayed on a gray-scale image. Objective: The aim of the study was using color and power doppler in targeting prostatic biopsy and detecting prostate cancer. Patients and methods: This prospective study included 100 consecutive patients attended Al-Azhar University Hospitals and National Institute of Urologyand Nephrology with lower urinary tract symptoms (LUTS), and have either Prostatic Specific Antigen (PSA)> 4 ng/ml or abnormal prostate on digital rectal examination (DRE). Patients with coagulopathy, history of prostate cancer diagnosis or evidence of a prostatic intraepithelial neoplasm of any grade were excluded. All patients were subjected to (DRE), International Prostatic Symptoms Score (IPSS), complete laboratory investigation including PSA, pelvi-abdominal ultrasound, gray-scale, color and power doppler TRUS, and TRUS-guided systematic biopsies with other focal lesion-targeted biopsies. Results: Histopathological examination of cores taken from hypo-echoic lesions revealed adenocarcinoma in 24 cases: 6 out of them were of group (A), and 18 were of group (B). So, cancer was detected in 50 % (6/12) of hypo-echoic lesions in group (A), and in 64.3% (18/28) of group (B) which was statistically significant. Correlation between the cores taken from hyper-vascular areas and the results of histopathology revealed that cancer was detected in 38 (74.5%) out of 51 hyper-vascular areas (8 out of them were of group A, and 30 were of group B). So, the incidence of cancer detection in hyper-vascular areas in group B (83.3%) was higher than group A (53.3%) which was statistically significant. Conclusion: The combination of color and power doppler ultrasound and gray-scale TRUS increased the sensitivity of detecting prostate cancer while not decreasing the specificity.