The Use of Micro-Ultrasound for Prostate Cancer Screening

A recent retrospective study evaluated high-resolution micro-ultrasound (MUS) as an imaging-based screening and risk-stratification

tool for prostate cancer in 682 men undergoing routine examination with PSA testing. Micro-ultrasound findings were scored and further refined by PSA density (PSAD) to define PSAD-modified positive and negative screening results. Biopsy and MRI were performed according to clinical guidelines.

Among the cohort, 62 men underwent biopsy . Prostate cancer was detected in 29 cases, with 18 being clinically significant (csPCa). PSA density-modified positive micro-ultrasound identified 15 of the 18csPCa cases. In contrast, only three csPCa cases occurred among those with a negative result. Compared to PSA-based biopsy thresholds, using PSA density-modified negative micro-ultrasound would have reduced unnecessary biopsies while missing a small number of cancers.

Compared to MRI-based biopsy criteria, it would have avoided extra negative biopsies and reduced MRI use, without missing any clinically significant cancer cases. These findings indicate that PSA density-modified micro-ultrasound is effective for detecting clinically significant prostate cancer while minimizing unnecessary procedures.

Overall, this screening system substantially reduced overdiagnosis, negative biopsies, and the detection of non-clinically significant cancers. It also maintained high sensitivity and negative predictive value for clinically significant prostate cancer. Micro-ultrasound alone showed strong odds for detecting clinically significant disease. The authors conclude that micro-ultrasound is effective for prostate cancer risk stratification in screening and warrants further prospective evaluation.

Prostate Cancer Prostatic Dis (2026). https://doi.org/10.1038/s41391-026-01075-x