Traditionally, transrectal ultrasound (TRUS)-guided biopsies are done for the diagnosis of prostatecancer (PCa) in Pakistan. The transperineal template-guided saturation biopsy (TTSB) approach hasbeen recently introduced in Pakistan and we share diagnostic yields and pathological findings ofspecimens taken for PCa diagnosis in men with elevated serum total prostate specific antigen (PSA)and negative TRUS-guided prostate biopsies. In all, 16 patients investigated at the Department ofUrology, Sindh Institute of Urology and Transplantation (SIUT), underwent TTSB. The mean ageof patients was 67.8 ± 8.8 (range: 55 - 84) years. The median PSA was 9.5 (IQR: 7.9 - 19.8) ng/ml. The duration of symptoms before biopsy ranged from 1 month to 144 months. The prostatewas enlarged with mean weight of 73.5 ± 55.5 g. Histopathology revealed PCa in 5 of 16 (31.2%)cases. The Gleason score was 6 (3+3), 7 (3+4) and 8 (4+4) in 1 case each (6.3%) and 10 (5+5) in 2cases (12.5%). At least two cores were positive in all positive cases. None of the patients requiredantibiotics post-procedure. In conclusion, the TTSB technique is a promising option for patients withelevated PSA level and negative transrectal prostate biopsies for the detection of PCa in our settin