To analyze the various techniques of transrectal ultrasound guided biopsy of the prostate described in the literature, as well as the anesthesia modalities for its performance. The diagnostic yield of the classic sextant biopsy, described 16 years ago and considered the standard technique ever since, has been overcome by the extended biopsy techniques (greater number of cores from more prostatic areas in each biopsy). Although their intra-study yield is better than sextant biopsy, the scarce randomized studies have not demonstrated a statistically significant improvement. These new techniques of extended biopsy significantly increase the rate of minor complications, not the major. It has not been demonstrated an increase in either the perception of pain or the diagnosis of non-significant tumors. Any anesthetic technique employed diminishes significantly the perception of pain by the patient. The periprostatic nerve blockage with infiltration of lidocaine is better than the rest of the techniques. The best technique of infiltration and the most effective lidocaine dose are to be defined yet. These techniques do not increase complications and only prolong the procedure briefly.