Home›Urology› Micro-US and MRI-targeted biopsy detect prostate cancer at comparable rates
Micro-US and MRI-targeted biopsy detect prostate cancer at comparable ratesMicro-ultrasound shows comparable results to MRI for prostate cancer
BJU internationalPublished August 4, 2026Study authors: Micheleto José Pedro Cassemiro, Suzuki Tallys Ávila, Santos Lucas Amorim, Sales Luann Porpino, Lopes…PubMed ↗DOI ↗Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic
AI-generated summary of the cited source, checked by automated accuracy review.
How we work
Share
Key Takeaway
Consider micro-US-TBx as a complementary diagnostic tool to MRI-TBx for prostate cancer detection.
This systematic review and meta-analysis compared micro-ultrasonography-targeted biopsy (micro-US-TBx) with magnetic resonance imaging-targeted biopsy (MRI-TBx) for detecting clinically significant prostate cancer (csPCa) in men with suspected prostate cancer or on active surveillance. The analysis included 22 studies, with 5,581 men undergoing micro-US-TBx and 5,937 undergoing MRI-TBx.
The primary outcome was the detection ratio (DR) of csPCa. The pooled DR was 1.04 (95% CI 0.95-1.15; I² = 61.1%), indicating comparable detection rates between the two modalities. Absolute numbers were similar: micro-US-TBx detected 2,037 cases and MRI-TBx detected 2,043 cases.
Secondary outcomes included sensitivity, specificity, positive predictive value, and negative predictive value. Sensitivity was 0.88 for micro-US-TBx and 0.81 for MRI-TBx, but this difference was not statistically significant (P = 0.192). Specificity was 0.25 and 0.17, respectively, also not significantly different (P = 0.257). The area under the curve (AUC) was higher for micro-US (0.658) compared to MRI (0.547), though no statistical comparison was reported.
The authors note that cost-effectiveness has not yet been defined. They emphasize that micro-US-TBx is not a replacement for MRI-TBx but may serve as a valuable complementary tool due to real-time imaging, accessibility, and potential workflow advantages. Certainty of evidence was rated using the GRADE framework, though the specific level was not reported.
In practice, these findings suggest that micro-US-TBx could be considered as an alternative or adjunct to MRI-TBx in diagnostic pathways, but further research is needed to clarify its role and cost-effectiveness.
How this fits prior evidence
This meta-analysis extends prior evidence on prostate cancer diagnostics by directly comparing micro-US-TBx with MRI-TBx. It confirms that micro-US-TBx achieves comparable detection of clinically significant prostate cancer, aligning with prior findings that AI improves diagnostic accuracy. It also addresses a gap by evaluating a non-MRI imaging modality, complementing prior coverage on PSMA-targeted therapies and prognostic tools. The comparable detection rates suggest micro-US-TBx could be integrated into pathways, but the lack of cost-effectiveness data limits immediate practice change.
When doctors look for prostate cancer, they need accurate ways to find tumors and decide on the best treatment. This study looked at two different imaging methods used before a biopsy: micro-ultrasound (micro-US) and magnetic resonance imaging (MRI). Both are used to help guide doctors toward the most concerning areas of the prostate.
The analysis compared 22 studies involving over 11,000 men. The results showed that both methods were very similar at finding clinically significant prostate cancer. While micro-ultrasound had a slightly higher area under the curve score, the difference in actual detection rates between the two tools was not statistically significant.
Because it works in real-time and is easy to access, micro-ultrasound could be a helpful extra tool for doctors today. However, researchers note that it is not meant to replace MRI. Instead, it may serve as a valuable partner in the diagnostic process to help ensure no cancer is missed.
What this means for you:
Micro-ultrasound and MRI show similar success rates in detecting significant prostate cancer during biopsies.
Common questions
Is micro-ultrasound as good as an MRI for finding prostate cancer?
Yes, the study found that both methods performed similarly. Specifically, the detection ratio for clinically significant prostate cancer was nearly identical between the two: 1.04 for micro-ultrasound and 2043 cases for MRI. While there were slight differences in other metrics like specificity, they were not statistically different.
What are the benefits of using micro-ultrasound?
Micro-ultrasound can be a valuable tool because it provides real-time imaging and is easy to access. These factors can offer advantages in the workflow for doctors trying to diagnose prostate cancer accurately.
Does this mean I can skip an MRI?
No, the study does not say micro-ultrasound replaces MRI. Instead, it is viewed as a helpful complementary tool. You should talk to your doctor about which imaging path is best for your specific situation.
OBJECTIVE: To refine prostate cancer (PCa) pathways by comparing micro-ultrasonography-targeted biopsy (micro-US-TBx) with magnetic resonance imaging (MRI)-TBx for detecting clinically significant PCa (csPCa) and by evaluating diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value).
METHODS: The Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), Excerpta Medica dataBASE (EMBASE), and ClinicalTrials.gov were searched on 4 July 2025 and updated 5 August 2025, without language/date limits. Eligible randomised and observational studies compared micro-US-TBx vs MRI-TBx (± systematic biopsy) in men with suspected PCa or on active surveillance; csPCa was Gleason Grade Group ≥2. Two reviewers screened/extracted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines; quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Detection ratios (DRs) were pooled with random-effects models; diagnostic accuracy used a bivariate random-effects model from 2 × 2 tables. Certainty of evidence was rated with the Grading of Recommendations, Assessment, Development, and Evaluation framework.
RESULTS: A total of 22 studies (micro-US-TBx = 5581; MRI-TBx = 5937) were included. Micro-US-TBx detected 2037 csPCa cases and MRI-TBx 2043. The pooled DR (micro-US-TBx vs MRI-TBx) was 1.04 (95% confidence interval 0.95-1.15; I = 61.1%). Pooled sensitivity/specificity were 0.88/0.25 for micro-US-TBx and 0.81/0.17 for MRI-TBx. Summary receiver operating characteristic curves overlapped (area under the curve: micro-US, 0.658; MRI, 0.547). Meta-regression found no significant modality effect on sensitivity (P = 0.192) or specificity (P = 0.257). Egger's test indicated no meaningful publication bias (P = 0.848).
CONCLUSION: The micro-US-TBx demonstrated csPCa detection and diagnostic accuracy comparable to MRI-TBx. Given its real-time imaging capability, accessibility, and potential workflow advantages, micro-US-TBx may represent a valuable complementary tool within contemporary PCa diagnostic pathways. Further cost-effectiveness studies are warranted to better define its role in clinical practice.
