Anticipated versus experienced pain in office-based transrectal and transperineal prostate biopsy under local anesthesia: a prospective comparative study

Abstract Background Prostate biopsy is commonly performed under local anesthesia in an office setting, making pain and tolerability important concerns. However, few studies have compared patients' expected pain with the pain they actually experience. This study prospectively compared expected and experienced pain in patients undergoing transrectal (TR) or transperineal (TP) biopsy. Methods This prospective observational study consecutively enrolled patients aged ≥18 years undergoing their first TR or TP prostate biopsy under local anesthesia in an office setting. Expected (pre-procedure) and experienced (immediately post-procedure) pain were recorded using a 0–10 Numerical Rating Scale (NRS). Willingness to repeat the procedure was recorded. Outcomes were compared between biopsy approaches and age groups (<65 vs. ≥65 years). Results Of 220 patients, 111 underwent TP and 109 underwent TR biopsy, with comparable baseline characteristics. Procedure duration was significantly longer in the TP group (13 vs. 8 min, p<0.001). Median experienced pain was lower than expected pain in both the TP and TR groups (3 vs. 7 in each; both p<0.001). Neither expected (p=0.789) nor experienced pain (p=0.715) differed between approaches, and the expectation–experience gap was similar (median 4 NRS points; p=0.814). Willingness to repeat (74.8% vs. 80.7%, p=0.293) did not differ between approaches, nor did pain outcomes by age. Conclusions Patients undergoing office-based prostate biopsy under local anesthesia experienced substantially less pain than they anticipated, regardless of age or biopsy approach. Whether incorporating these findings into pre-procedural counseling can reduce anxiety or improve patient comfort warrants prospective evaluation.