OBJECTIVES: The objective of our study was to evaluate patient tolerance to transrectal ultrasound guided prostate biopsy using anesthesia with 2 grams of intrarectal lidocaine gel, and to evaluate the complications of the test. METHODS: 148 prostate biopsies with intrarectal lidocaine were performed over a four month period. The same intrarectal ultrasound transducer and needle mechanism were employed for all patients. Biopsies were performed by 7 different urologists with 6 to 12 cores per biopsy. All patients received after the biopsy a questionnaire to evaluate their tolerance to the intervention. In the same way, the urologist performing the biopsy filled a questionnaire about patient tolerance and complications of the test. RESULTS: Patient tolerance data were recorded in 147 biopsies. Twenty-five cases (16.9%) referred severe or unbearable pain, 45 patients (13.4%) referred no pain at all. A significant association between patients' and doctors' results was obtained. Digital rectal examination was painful in 10 cases only; transducer insertion was painful in 13, and 15 referred pain with the transducer movements inside the rectum. Almost all painful or unbearable core biopsies were taken in the apex. There was a significant association (p = 0.005) between the number of cores per biopsy and pain, being the pain more than expected when the number of cores was greater than six. Only 14 patients would not ever repeat the same biopsy or would request a different type of anesthesia and 133 (59.9%) of them would repeat it in the same way. CONCLUSIONS: In our experience, transrectal ultrasound guided prostatic biopsy is generally well tolerated with intrarectal gel as the only anesthesia. Nevertheless, the number of cores taken per biopsy has been the factor associated with pain, and if the number of biopsy cores increases additional anesthesia should be considered.