Background: A transrectal ultrasound-guided prostate biopsy is currently the gold standard procedure to detect prostatic adenocarcinoma. There is little information on the clinical utility of this technique for the detection of prostate adenocarcinoma in men with suspected prostate cancer in Pakistan. This study seeks to determine the frequency of prostatic adenocarcinoma by using a transrectal ultrasound-guided octant prostate needle biopsy protocol in men with clinical suspicion of cancer.Methods: All adult men, aged ≥40 years that consecutively presented with signs and symptoms of prostatism, an abnormal digital rectal examination and/or elevated serum total prostate specific antigen levels at Sindh Institute of Urology and Transplan- tation, Karachi, Pakistan from March 2011 to February 2012, and who underwent transrectal ultrasound-guided biopsies were included. In most patients, eight cores were taken per case. Each core was separately labeled and processed for histopathological evaluation.Results: A total of 203 men underwent transrectal ultrasound-guided prostate biopsies during the study period. The mean age of all patients was 65.7±9.3 years. The median serum total prostate specific antigen level was 21.6 ng/ml. The overall frequency of detection of prostate adenocarcinoma in this cohort was 48.8% (99/203). The mean number of positive cores per case was 6.02±2.25; the minimum was one and the maximum, eight.Conclusion: This study showed a similar detection rate for prostate cancer to that reported in studies from Asian and Western countries. The detection rate was markedly higher compared to a few local studies, which showed a very low incidence because of the unavailability of transrectal ultrasound-guided needle biopsies and lack of prostate specific antigen screening programs.