MICRO-ULTRASOUND-GUIDED prostate biopsy may offer comparable diagnostic performance to magnetic resonance imaging (MRI)/ultrasound fusion biopsy for detecting clinically significant prostate cancer (csPCa), according to a large propensity-weighted comparative study.
Propensity-Weighted Comparison of Biopsy Techniques
The retrospective analysis included 1,119 men with MRI-visible prostate lesions who underwent prostate biopsy between 2019 and 2022. Of these, 767 received cognitively targeted micro-ultrasound–guided biopsy (MB), while 352 underwent MRI/ultrasound fusion-guided biopsy (PFB). To minimise baseline differences between the groups, the investigators applied inverse probability of treatment weighting using a propensity score model. Outcomes were assessed in the overall cohort, as well as in subgroups of biopsy-naïve patients and those with anterior prostate lesions.
Micro-Ultrasound and Its Impact on Biopsy Accuracy
Following adjustment, combined sampling with micro-ultrasound resulted in higher detection rates of clinically significant prostate cancer compared with MRI fusion biopsy (45% versus 34%). This corresponded to a significantly greater likelihood of detecting csPCa using micro-ultrasound in weighted analyses. However, when targeted biopsies alone were considered, no significant differences were observed between the two techniques in the overall population or among biopsy-naïve men. Similarly, detection rates in patients with anterior prostate lesions were comparable between groups.
Multivariable analysis of the full cohort identified micro-ultrasound use and Prostate Imaging–Reporting and Data System (PI-RADS) 5 lesions as independent predictors of clinically significant disease. These findings suggest that lesion characteristics continue to play a critical role in cancer detection, regardless of biopsy technique.
The study also assessed concordance between biopsy findings and radical prostatectomy specimens. Gleason score upgrading at prostatectomy was significantly more common in the MRI fusion biopsy group compared with the micro-ultrasound group, raising questions about potential undergrading with MRI-based targeting in some cases.
The authors note that while micro-ultrasound demonstrated a higher overall detection rate of clinically significant prostate cancer after statistical adjustment, this advantage was not consistent across all clinical scenarios. They conclude that further prospective studies are required to determine whether the observed differences reflect true methodological superiority or context-specific factors such as operator experience, lesion location, or patient selection.
Reference
Castilho Borges R et al. Detection of clinically significant prostate cancer using micro-ultrasound vs magnetic resonance imaging/ultrasound fusion biopsy: a propensity-weighted comparative study. J Urol. 2026; 215(2):153–63.
