The objective of this study is to evaluate the performance of urology residents at each training level in detecting prostate cancer with transrectal ultrasound-guided (TRUS) biopsy. The inclusion criteria were: (1) prostate-specific antigen (PSA) 4-10 ng/ml; and (2) 10-12 cores per biopsy session. Data from repeat biopsy sessions were excluded. Overall prostate cancer detection rate for 170 patients was 39.4%. PSA, digital rectal examination (DRE), and prostate volume were predictors of cancer detection. There were no significant differences in overall cancer detection rates, PSA, DRE, or prostate volume between resident levels. In conclusion, urology residents at all levels of training perform equally well at detecting cancer using TRUS prostate biopsy technology.