Trans-rectal ultrasound (TRUS) guided biopsy of the prostate was first described in 1937. TRUS and prostatic biopsy allow samples of the prostate to be taken for histological assessment to detect the presence of cancer. Indications include abnormal digital rectal examination or elevated levels of serum prostatic specific antigen (PSA). Modern TRUS probes are 5-8MHz and are high-resolution with multi-axial planar imaging capabilities. This allows for both transverse and sagittal imaging of the prostate in real time. The handheld probe is fitted with an adapter hat accepts the needle into the biopsy gun. The ability to visualise the prostate allows for targeted placement of the biopsy needles into various regions of interest. Routine practice over the past decade is to take multiple prostatic cores (8-12) using a spring loaded core biopsy device. Firstly, in order to minimise the risk of missing cancer and secondly, to gain information about the proportion of the prostate involved by tumour and of what tumour grade. There has been no consensus on the size of needle to be used but increasingly, pathologists are reporting inadequate biopsy specimens being provided. Many strategies are available to minimise the pain that patients perceive. Anaesthesia can be achieved by administering propofol to achieve sedation or via local anaesthetic infiltration with lignocaine to the peri-prostatic nerves. Other anaesthetic options include topical glyceryl trinitrate (GTN) cream, topical lignocaine, nitrous oxide or Entonox.