Aim: We aimed to compare the two groups, topical plus intrarectal local anesthesia and periprostatic nerve blockage in Transrectal ultrasound guided biopsy (TRUS-Biopsy) by means of pain perception. Material and Method: Between October 2012 and 2013, 190 patients included in the study with increased prostate specific antigen (PSA) levels and/or abnormal digital rectal examination findings whom underwent 12 core TRUS biopsy. Some patients are medicationed with perianal %5 lidocaine firstly, and then with intrarectal 10 cc %2 lidocaine gel (Group 1), other group was medicationed with periprostatic 10cc %2 lidocaine solution with 20 Gauche needle (Group 2). There was 103 patients in Group 1, and 87 patients in Group 2. Results: There was no statistically significant relation between visual analog scale (VAS) scores and prostate volume, age, pathology result, Gleason score, and perineural invasion. The mean VAS score was 3,02 (0,3-7,6) in Group 1; and 1.9 (0,3-3,9) in Group 2. When the VAS score was compared between groups, statistically significant difference was found (p=0,01). Discussion: While we used 2 agents topically around anus and intrarectally in Group 1, pain perception was decreased more in the periprostatic blockage group. This showed us puncturing of needle through prostate capsule results in higher pain perception. Because this procedure is mostly done in the outpatient clinics, periprostatic blockage should be the choice of local anesthesia for relieving pain.