Micro-ultrasonography- vs MRI-targeted biopsy in prostate cancer: Updated systematic review and meta-analysis.

Abstract

To refine prostate cancer (PCa) pathways by comparing micro-ultrasonography-targeted biopsy (micro-US-TBx) with magnetic resonance imaging (MRI)-TBx for detecting clinically significant PCa (csPCa) and by evaluating diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value). The Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), Excerpta Medica dataBASE (EMBASE), and ClinicalTrials.gov were searched on 4 July 2025 and updated 5 August 2025, without language/date limits. Eligible randomised and observational studies compared micro-US-TBx vs MRI-TBx (± systematic biopsy) in men with suspected PCa or on active surveillance; csPCa was Gleason Grade Group ≥2. Two reviewers screened/extracted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines; quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Detection ratios (DRs) were pooled with random-effects models; diagnostic accuracy used a bivariate random-effects model from 2 × 2 tables. Certainty of evidence was rated with the Grading of Recommendations, Assessment, Development, and Evaluation framework. A total of 22 studies (micro-US-TBx = 5581; MRI-TBx = 5937) were included. Micro-US-TBx detected 2037 csPCa cases and MRI-TBx 2043. The pooled DR (micro-US-TBx vs MRI-TBx) was 1.04 (95% confidence interval 0.95-1.15; I² = 61.1%). Pooled sensitivity/specificity were 0.88/0.25 for micro-US-TBx and 0.81/0.17 for MRI-TBx. Summary receiver operating characteristic curves overlapped (area under the curve: micro-US, 0.658; MRI, 0.547). Meta-regression found no significant modality effect on sensitivity (P = 0.192) or specificity (P = 0.257). Egger's test indicated no meaningful publication bias (P = 0.848). The micro-US-TBx demonstrated csPCa detection and diagnostic accuracy comparable to MRI-TBx. Given its real-time imaging capability, accessibility, and potential workflow advantages, micro-US-TBx may represent a valuable complementary tool within contemporary PCa diagnostic pathways. Further cost-effectiveness studies are warranted to better define its role in clinical practice.