The Role of Micro-Ultrasound in Prostate Cancer Detection

Abstract Purpose of Review 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. Recent Findings 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. Summary MicroUS is a practical, high-resolution platform that complements mpMRI and may enhance accessibility, efficiency, and precision in prostate cancer care.