Impact of music on pain perception during office-based transperineal prostate biopsy: a prospective non-randomized study.

Although music has been shown to alleviate pain and anxiety during transrectal PBx, limited evidence is available regarding its impact in the transperineal (TP) setting. This study aimed to investigate the effect of music on pain perception during office-based TP PBx. This prospective, comparative, non-randomized study enrolled biopsy-naïve patients undergoing TP PBx between March 2024 and March 2025. A total of 200 patients were equally assigned to the intervention group (listening to music during PBx) or the control group. Pain was assessed using the Visual Analog Scale (VAS) at six predefined timepoints (T0–T5). A differential pain score (D-VAS) was calculated at each timepoint, using the VAS score at T0 as the baseline. Changes over time between the two groups were analyzed using independent t-tests and a linear mixed-effects model. An interaction term between music and timepoints was included to test whether the effect of music on pain perception varied across the different stages of the procedure. Compared with controls, D-VAS was significantly lower in the music group at the first core (T3, p = 0.025), last core (T4, p < 0.001) and at discharge (T5, p < 0.001). No significant differences were observed during local anesthesia (T1-T2). The Mixed-effects model confirmed these findings and revealed that both pain perception and the relative analgesic effect of music varied accross different stages of the procedure. Listening to music was associated with lower pain perception during TP PBx, particularly during biopsy sampling phases, and resulted in lower pain levels at discharge.