Aim: To assess the safety and feasibility of transrectal ultrasound (TRUS) guided free‑hand transperineal prostate biopsy under local anesthesia (LA) for suspected prostate cancer. Methods: The present study was conducted in the Department of urology, Rajendra Institute of medical sciences (RIMS), Ranchi, Jharkhand, India for a period of 18 months. Total 40 patients were included in the study. Institutional Ethics Committee approval was obtained before initiation of this study. Informed consent and patient information sheet were explained in detail to the study subjects prior to their enrolment. Results: Out of 30 cases of malignancy, 28 (93.33%) cases showed clinically significant cancer (International Society of Urological Pathology class ≥2), and remaining 2 cases were clinically insignificant cancer (ISUP class <2). Over 91% of patients with PIRADS score 4 or 5 and 66.7% of patients with PIRADS score 3 showed malignancy. The odds of having malignancy in PIRADS 4 or 5 lesions was five times more than in PIRADS 3 lesions (OR 5.5, P = 0.033, 95% confidence interval 1.02–29.6). Around 84% of patients had abnormal DRE and all of them had malignancy. Of all patients, only 5 developed complications after procedure (four had hematuria, one had acute urinary retention and none presented with either hematospermia or hematochezia). Conclusion: Freehand TRUS‑guided transperineal prostate biopsy vvith coaxial needle technique under LA is a safe procedure with good tolerability, good CDR, and five complications, especialy no sepsis. In our population group, this approach is cheaper vvith less hospital stay and good patient tolerance .