Abstract Background Cancer prostate is considered one of the most common cancers among male population. Trans rectal ultrasound (TRUS) guided biopsy has become the main procedure for diagnosing prostate carcinoma, In order to definitively diagnose prostate carcinoma, (TRUS)-guided prostate biopsy is needed. Aim of the Work To compare the efficacy, safety of Pudendal nerve block plus periprostatic nerve block with the standard technique (periprostatic nerve block). Patients and Methods during a period of 6 months duration A total of 30 patients (group 1 [Pedundal nerve block plus periprostatic nerve block], n = 15; group 2 [periprostatic nerve block], n = 15) were included in the study. all patients were instructed about how to assess pain and discomfort level using a visual analog scale (VAS) from 0 to 10, with an 11-point score (0 = no pain, 10 = intolerable pain). Results in our study 30 male patients were divided into 2 groups, group 1 underwent to (PPNB) and group 2 (PPNB + pudendal block). The mean age of the studied group was 58.8 ± 10 years old. All patients hadn’t previous history for prostate surgery nor for rectoanal disease. In our study we evaluated pain scores immediately after the procedure. Regarding the relation between VAS and two studied group, there was an increase in VAS in group 1 more than group 2 along the three sets of follow up with statistical difference between two studied groups in all follow ups as p-Value was <0.05. Conclusion our data suggest that combined bilateral pudendal nerve block plus periprostatic nerve block is more effective than periprostatic nerve block alone in reducing the pain during TRUS guided prostate biopsy.