Abstract
Background:
Multiparametric magnetic resonance imaging has reshaped prostate cancer diagnostics but is limited by cost, accessibility, and workflow complexity. High-resolution micro-ultrasound offers real-time lesion visualization and targeted biopsy capability as a potential complementary imaging modality.
Methods:
A narrative review of the literature was conducted using PubMed and Embase from inception to March 2026. Search terms included “micro-ultrasound,” “MicroUS,” “29 MHz ultrasound,” “PRI-MUS,” “prostate cancer,” “clinically significant prostate cancer,” “biopsy,” and “active surveillance.” Priority was given to randomized trials, prospective comparative studies, systematic reviews, and meta-analyses.
Results:
Micro-ultrasound demonstrates high sensitivity for clinically significant prostate cancer, with randomized evidence from the OPTIMUM trial supporting noninferiority to magnetic resonance imaging–based diagnostic pathways. Prospective studies suggest that micro-ultrasound enables real-time lesion targeting and may detect clinically significant prostate cancer not identified by multiparametric magnetic resonance imaging, supporting a complementary role in combined diagnostic strategies. However, specificity and biopsy-avoidance capacity remain lower than those of multiparametric magnetic resonance imaging. In active surveillance, micro-ultrasound serves as an adjunct for targeted biopsy but does not replace MRI-based protocols.
Conclusions:
Micro-ultrasound is a promising complementary imaging modality that enhances real-time targeting and workflow efficiency. Its primary role lies in integration within multimodal diagnostic pathways rather than replacement of multiparametric magnetic resonance imaging. Further multicentre validation and standardization are required to define its role in clinical practice.
Level of evidence:
Not applicable.
Keywords
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