The Role of Micro-Ultrasound in Prostate Cancer Detection

To synthesize current evidence on the role of 29-MHz micro-ultrasound (microUS) in prostate cancer (PCa) detection and to define its position relative to multiparametric MRI (mpMRI) across the diagnostic pathway. We conducted a narrative review of prospective, comparative, and randomized studies, with clinically significant prostate cancer (csPCa) detection as the primary endpoint.

MicroUS provides ~ 70-µm axial resolution and enables real-time PRI-MUS-based risk stratification. Across head-to-head studies, microUS achieves diagnostic performance comparable to mpMRI. Evidence supports utility in biopsy-naïve patients, selected MRI-negative men with persistent clinical suspicion, repeat-biopsy settings, active surveillance, and local tumor staging, while combined mpMRI-microUS approaches have been shown to maximize yield of csPCa detection. Key limitations include operator dependence, interobserver variability, lack of validated biopsy-avoidance thresholds, and reduced sensitivity in anterior lesions. MicroUS is a practical, high-resolution platform that complements mpMRI and may enhance accessibility, efficiency, and precision in prostate cancer care.