Prostate cancer is one of the most common cancers in men.Tissue for diagnosis and risk stratification is generally obtained by a prostate biopsy.Prostate biopsy evolved fromTrans-rectal,Trans-perineal,Systematic &Targeted approaches.There are several novel developments in the field.Robotic techniques to guide biopsy needles based on fusion images.Directly targeting lesions robotically during in-bore magnetic resonance imaging. Here we talk about modification of finger guided biopsy which is still relevant in many parts of southern Asia . Aim is to assess the efficacy and safety of modification of prostate biopsy in a tertiary health care centre. Objectives: 1. Procedure time 2. Pain score(VAS) 3. Blood loss 4. Surgeons feasibility 5. Assessment of needle stick injury 6. Post-procedural complications

Study Design:Prospective observational study with institutional ethical clearance at SIMS & RC and Clinical Trails Registry India (CTRI) Sample Size: 30 patients. Study Duration: June 2024 to August 2024 (3 months) Inclusion criteria: 1.Positive DRE examination 2.PSA > 4-10 ng/ml based on patient risk-benefit analysis. Exclusion criteria: 1.Fissure-in-ano 2.Hemorrhoids 3.Coagulation disorders 4.Perianal codylomata 5.Severe immunosuppresion 6.Acute prostatitis Patient followed-up on ;Day 1 telephonically and on Day 3 with Histopathology report. Procedure: Prostatic nodules to be visualized under vision through proctoscope under light source with a peri prostatic plexus block ; double sextant core biopsies are taken.

Average procedural time was 4 minutes;Pain score (VAS) was 3;Blood loss was minimal around 5ml;This is feasible to most of the surgeons;No needle stick injury recorded; 4 patients had hematuria post procedurally and no other complications.Out of 30 samples;23 are positive for malignancy histopathologically.

Advantages of doing this procedure are Easy Effective Quick Prevents needle stick injury to the surgeon Under vision Reproducible in tertiary as well as peripheral medical centres This is the a very important modification of a finger guided biopsy which is still relevant in many parts of India ,South Asia subcontinent as the facilities and affordability are yet to be improved in many parts of country .This definitely prevents needle stick injury to the surgeon which accidentally happens many at times during finger guided biopsy .Only disadvantage is sometimes the tissue diagnosis from apex of prostate may be missed out .This procedure can be reproduced in many centres where finger guided biopsy is still being done .This procedure is safe and may be done in other centers.