Background: Prostate biopsy is a commonly performed procedure done in the evaluation of elevated prostate specific antigen (PSA), abnormal digital rectal exam (DRE), or for patients with a known prostate cancer diagnosis on active surveillance. The diagnostic yield of prostate biopsy is related to patient factors including age and race, but may also be correlated with provider factors, including clinical experience and training. We aim to determine the relationship between urologic oncology fellowship training (UOFT) and years of training with diagnostic yield of prostate biopsy. Methods: A retrospective review was conducted of patients who underwent prostate biopsy across the Cleveland Clinic between 2000 and 2018. Biopsies done by urologists with and without UOFT were detailed via descriptive statistics and with appropriate (chi square, Student t) tests. Logistic regression was performed, adjusting for last PSA, age, race, and type of biopsy. Results: A total of 11,255 biopsies performed by 129 urologists had complete information for review. The average patient age at biopsy was 65 years. The mean number of years in practice was 16 with a range from < 1 to 46 (SD 11.26). Of 129 urologists 16 (12.4%) had completed a urology oncology fellowship. Those with UOFT were more likely to use MRI guidance for biopsy (7.73% v 2.89%). Overall, 35.5% of all biopsies were positive for prostate cancer, with a significantly higher rate of positive biopsy for urologists with UOFT (40.7% v 32.43%, OR 1.4, p < 0.0001). Having completed greater than 5 years of clinical practice was correlated with greater odds of positive biopsy (OR 1.170, p < 0.0001), but significance of this association was lost when adjusting for oncology fellowship. UOFT remained a significant predictor of diagnostic yield even when adjusting for most recent PSA, age and race of patient, provider years in practice, and type of biopsy (MRI v transrectal ultrasound). Conclusions: Urologic oncology fellowship training is associated with a higher diagnostic yield on prostate biopsy, and a higher uptake of MRI guided biopsy. Higher rate of positivity on biopsy may be attributable to more nuanced patient selection for biopsy or to biopsy technique.