Control of pain associated with TRUS guided biopsies was the target of many researches that tried peri-prostatic local infiltration anesthesia (PLIA) either basal, apical, combined or topical anesthesia (TA). Thus, the efficacy of (PLIA) alone versus (PLIA) combined with (TA) in pain control during TRUS guided biopsies was compared. A total of 163 patients with a mean age±2stdev (61±1.4 years) and a mean PSA ± 2stdev (8.5±1.1ng/ml) 84 patients (G1) were randomized to receive either PLIA alone (G1) or 79 patients (G2) combined TA (using lignocaine 5% ointment of the anal ring, anal canal, and anterior rectal wall and basal PLIA via injecting 5 ml 2% xylocaine in both sides of the base), with cross-matched mean ages. Patients were asked to scale pain from 0-10 during probe insertion (P1), periprostatic infiltration (P2) and after taking biopsies in all patients (P3) using the visual analogue pain scale to complete a visual analogue scale questionnaire. The patients in G2 showed significantly less pain scores at all stages of the procedure (P1, P2 & P3) in comparison to patients in G1 especially regarding P1 and P2. The mean reported pain score was 24, 4±5, 6 and 15, 8±3.8 for G1 & G2 respectively, with significant difference (p=0,022).