Systematic review and meta-analysis compares micro-ultrasound and mpMRI guidance for prostate biopsy cancer detection

OBJECTIVE: To investigate the diagnostic value of micro-ultrasound (micro-US) and multiparametric magnetic resonance imaging (mpMRI) guidance for clinically significant prostate cancer (defined as grade group ≥ 2, csPCa), and to compare their detection rates for clinically insignificant prostate cancer. METHODS: We conducted a search of PubMed, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), China Wanfang Data, Cochrane Library, and ClinicalTrials.gov, covering the period from their inception up to August 2025, to identify studies on micro-ultrasound and mpMRI-guided prostate biopsy. RESULTS: From the initial pool of 590 screened studies, 11 studies (including 10 original articles and 1 clinical database registry trial) were included in our analysis after applying strict inclusion and exclusion criteria. These studies involved a total of 3667 patients who underwent micro-ultrasound-guided prostate biopsy and 3887 patients who underwent mpMRI-guided prostate biopsy. The pooled analysis indicated no significant variation in csPCa detection rates between the 2 biopsy methods (odds ratio [OR] = 1.13; 95% confidence interval [95% CI:] 0.99-1.30; P = 0.07). Similarly, no significant difference was observed between the 2 methods in detecting ciPCa (OR = 0.89; 95% CI: 0.72-1.09; P = 0.25). CONCLUSIONS: The pooled analysis indicated no statistically significant difference in csPCa detection rates (OR = 1.13; 95% CI: 0.99-1.30; P = 0.07). Micro-ultrasound-guided prostate biopsy has similar ability to mpMRI in identifying clinically significant cancers while detecting fewer clinically insignificant cancers. Therefore, micro-ultrasound-guided prostate biopsy may be considered a suitable alternative or even a complementary approach to mpMRI-guided biopsy.