Objectives. To prospectively evaluate the efficacy of apical and lateral periprostatic lidocaine injection as anesthesia during transrectal ultrasound-guided prostate biopsy.

Methods. A total of 152 consecutive men undergoing transrectal prostate biopsy in our department were enrolled in this study. Patients were randomized into group 1 (74 patients) who received 15 mL of 1% lidocaine in the lateral and apical periprostatic regions, 5 mL in each point, 10 minutes before the prostate biopsy, and group 2 (78 patients), controls. Pain after each biopsy (a total of 10 biopsies) was assessed using a 10-point linear visual analog pain scale.

Results. In groups 1 and 2, the mean patient age was 64.8 and 65.8 years (P = 0.4), mean prostate-specific antigen was 10.9 and 11.2 ng/mL (P = 0.9), and mean prostate volume was 57 and 60 cm³ (P = 0.5), respectively. The mean total pain score (sum of each biopsy score, total of 10 for each patient) during transrectal prostate biopsy was 16 (range 0 to 62.5) and 50 (range 0 to 100) in groups 1 and 2, respectively (P = 0.0001). No adverse events were noted.

Conclusions. Transrectal ultrasound-guided lateral and apical periprostatic anesthesia significantly diminishes the pain in men undergoing transrectal prostate biopsy. We recommend that this procedure be routinely offered to all patients undergoing transrectal prostate biopsy.