Purpose: To prospectively evaluate efficacy of periprostatic Lidocaine injection as anesthesia during transrectal ultrasound-guided prostate biopsy compared to the conventional method.Methods: A prospective study in 100 patients underwent TRUS-guided prostate biopsy was conducted. Patients were randomized into 2 groups: group 1 (56 patients), who received 10 ml of 1% Lidocaine at periprostatic region; group 2 (44 patients), control patients, who did not have any anesthesia. After the procedure, pain score was assessed using a visual analog pain scale 0-5.Results: Both groups were not significant difference at, age, number to rebiopsy, PSA level, pathological finding and complication rate. There was a significant difference in pain score between the two groups (group 1 = 2.41, group 2 = 3.02 (p=0.006).Conclusions: Periprostatic local anesthesia (bilateral periseminal infiltrations) significantly decreases pain associated with TRUS-guided prostate biopsy, we recommend this procedure be routinely offered to patients undergoing TRUS-guided prostate biopsy.