AI in High-Frequency Micro-Ultrasound: Advancing Prostate Imaging from Segmentation to Cancer Detection

Background/Objective: High-frequency micro-ultrasound (micro-US) offers real-time, high-resolution imaging for prostate cancer. Although artificial intelligence (AI) has shown potential in enhancing micro-US interpretation, a comprehensive review of this emerging field is currently missing. This review synthesizes current evidence on AI applied to ExactVu 29 MHz micro-US for prostate cancer. Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library were searched up to December 2025. Studies were included if they applied machine learning or deep learning directly to 29 MHz micro-US data and reported quantitative performance metrics. Results: Ten studies met the inclusion criteria: six on prostate cancer detection, three on prostate segmentation and one on micro-US–histopathology registration. Detection models ranged from classical quantitative ultrasound machine learning to deep architectures using self-supervision, transformers, multiple-instance learning, ensemble calibration and 3D segmentation-based pipelines. Among core-level models for clinically significant cancer, area under the receiver operating characteristic curve (AUROC) values clustered around 0.76–0.81; one lesion-level framework reported an AUROC of 0.92, though at a non-comparable analytical unit. Segmentation studies achieved accurate prostate delineation (Dice similarity coefficient ≈ 0.94), and a single study demonstrated high-precision 3D registration to whole-mount histopathology (Dice similarity coefficient 0.97 and landmark error < 3 mm). All studies evaluated AI on previously acquired data, without real-time clinical implementation. Conclusions: AI for micro-US shows promising and reproducible early results across detection, segmentation and registration, but evidence is still limited. In view of the potential of AI to optimize micro-US utilization and its related advantages, additional efforts are warranted to achieve clinical adoption.