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Sedation may result in reduction in pain during transrectal ultrasound(TRUS)-guided prostate biopsies.We aimed to evaluate the efficacy and safety of a combination of propofol and remifentanil infusion during TRUS-guided prostate biopsy and the related increases in health care costs.From January to September 2010,100 men undergoing a transrectal prostate biopsy were randomized into two groups.In Group 1,[50]patients received a combined infusion of propofol and remifentanil; in Group 2,[50]patients received lidocaine jelly.After TRUS-guided biopsies were performed,pain and patient satisfaction were evaluated by a 10-point visual analog scale (VAS),and a cost-related patient satisfaction questionnaire was completed by all patients.Patients were also asked whether they would be willing to undergo repeat biopsy by the same method.Patients in Group 1 showed a significantly lower VAS score than those in Group 2 (mean VAS score: 0.9士1.1 versus 6.312.5; P<0.001).In addition,the patient satisfaction scale was significantly higher in Group 1(P=0.002).Although the overall cost was significantly higher in Group 1(P=0.006),patient satisfaction scales considering cost were also higher in this group (P=0.009).A combination of propofol and remifentanil is a safe and effective way to decrease patient pain and increase patient satisfaction during TRUS-guided prostate biopsy.Although the costs were higher in the group that received sedation,as expected,the patients exhibited heightened satisfaction and willingness to repeat biopsies by the same method.