Objective To investigate the safety of transrectal ultrasound guided prostate biopsy (TUPB)and its role in early diagnosis of prostate cancer(PCa) by analyzing the large sample data of a single center. Methods Between June 2005 and August 2014, 3256 consecutive patients with an age range from 50 to 80 years (average 69 years),underwent TUPB at Changhai hospital. Prostate specific antigen (PSA) and prostate volume was evaluated; and 12 cores biopsy was undertaken with separate Gleason score evaluation for each core.Student’s t test was used for statistically analysis. Results The positive predictive value (PPV) of cancer was 34.2%, and the median PSA and Gleason score of PCa patients were 22.8 ng/ml and 7. When the PSA value ranged less than 4.0, 4.1-10.0, 10.1-20.0, 20.1-50.0 ng/ml and 50.0ng/ml or more, PPV was 10.1%, 17.3%, 23.8%, 54.6%, and 90.7%, respectively. Of all the patients with PCa, 43.5% had PSA less than 20ng/ml.A total of 6 patients had infection and of them 2 patient had severe sepsis; 45 patients had rectal bleeding but only 2 patients needed treatment; the other minor complications were acute urine retention,haematouria and vasovagal syncope. All the patients convalesced without sequela. Conclusions TUPB is safe and effective and combination with PSA screen is still the standard for early diagnosis of PCa in China so far, regardless of continuous challenging from upto-date biopsy technique.