Micro-ultrasound guided versus multiparametric MRI-guided prostate biopsy: a systematic review and meta-analysis

PURPOSE: To investigate patients with suspected prostate cancer, multiparametric MRI (mpMRI) has been the standard imaging modality employed. However, mpMRI is costly and not universally available. Microultrasound (mUS), a novel 29-MHz modality, offers high-resolution, real-time prostate imaging and may guide biopsy with comparable diagnostic accuracy. This systematic review and meta-analysis compares mUS-guided and mpMRI-guided prostate biopsy for the detection of prostate cancer (PCa). METHODS: A systematic search was conducted up to April 2025, in accordance with the PRISMA guidelines (PROSPERO ID CRD420251033768). Comparative studies reporting PCa detection between mUS and mpMRI were included. RESULTS: Twelve studies comprising 4318 patients (3475 mUS; 3615 mpMRI) were included. There was no significant difference between modalities in the detection of clinically significant prostate cancer (csPCa), both overall (RR 0.97; 95%CI 0.90-1.05) and with targeted biopsy (RR 1.05; 95%CI 0.97-1.14). Overall cancer detection was also comparable (RR 1.00; 95%CI 0.87-1.15), as was Grade Group 1 prostate cancer detection, whether assessed across all biopsies (RR 1.00; 95%CI 0.72-1.39) or with targeted biopsy alone (RR 0.90; 95%CI 0.64-1.27). Weighted pooled values showed mUS had a sensitivity of 93.2%, specificity of 23.3%, positive predictive value (PPV) of 46.4%, and negative predictive value (NPV) of 81.2%, compared with mpMRI's sensitivity of 87.5%, specificity of 25.7%, PPV of 44.6%, and NPV of 73.7%. CONCLUSION: mUS-guided biopsy demonstrates diagnostic performance comparable to mpMRI-guided biopsy for PCa detection and represents a promising alternative or adjunct to mpMRI in prostate cancer diagnostic pathways.