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

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