We retrospectively reviewed the files of patients who had transperineally undergone a systematic six sextant prostate biopsy under guidance of transrectal ultrasound in longitudinal transsection by using Biopsy needle with the spring-roaded Biopsy gun. Of the 442 patients with suspicious glands visiting our clinic between May in 1992 and February in 1998, 486 biopsies were taken and pathological diagnosis was made to be prostate cancer in 153 (34.6%) patients, benign prostate hyperplasia in 270 and prostatitis in 19. Positive predictive values obtained in this series were calculated to be 49.4% in digital rectal examination (DRE), 55.0% in transrectal ultrasonogram (TRUS), 47.8% in prostate-specific antigen (PSA) level 4 ng/mL or greater and 83.5% if a patient had positive DRE and TRUS and PSA level 4 ng/mL or more. Relationship between number of positive cores and clinical stage of the patients was found (p < 0.0001). No complications relating to the biopsy were observed. This transrectal ultrasound guided transperineal systematic six sextant prostate biopsy was thought to be one of useful tools of the biopsy for detecting prostate cancer.