Microultrasound-targeted biopsies in patients with suspected prostate cancer: Diagnostic accuracy and clinical utility.

[BACKGROUND] Microultrasound (microUS) is an emerging imaging modality that enables real-time, high-resolution prostate cancer detection.

[OBJECTIVES] To evaluate the diagnostic accuracy and clinical utility of microUS-targeted biopsies for the detection of clinically significant prostate cancer (csPCa) in a real-world cohort of patients with suspected disease.

[MATERIALS AND METHODS] We retrospectively analyzed 200 patients who underwent transperineal microUS-guided prostate biopsy between January 2022 and December 2024. All procedures were performed using the 29 MHz ExactVu system, applying the PRI-MUS scoring system for lesion characterization. Targeted biopsies were followed by 12-core systematic sampling. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Multivariate logistic regression was conducted to identify predictors of csPCa.

[RESULTS] Prostate cancer was detected in 124 patients (62.1%), with csPCa confirmed in 84 cases (42%). Lesions with PRI-MUS ≥4 were significantly associated with csPCa (P = 0.018), yielding a sensitivity of 93% and NPV of 83%. Among patients with negative or absent multiparametric magnetic resonance imaging (mpMRI) (n = 30), microUS identified csPCa in 16.7%. ISUP grade concordance between targeted biopsies and final prostatectomy specimens was 84.8%. PRI-MUS score emerged as the strongest independent predictor of csPCa (OR: 2.96; P = 0.001). The overall complication rate was 4%, exclusively minor events.

[CONCLUSIONS] MicroUS-targeted biopsies demonstrate robust diagnostic performance in identifying csPCa, particularly with PRI-MUS scores ≥4. Its real-time imaging capabilities, broad accessibility, and short learning curve suggest that microUS may serve as a reliable alternative or adjunct to mpMRI in contemporary prostate cancer diagnostic pathways.