The role of micro-ultrasound in active surveillance for prostate cancer

Daniel Ajabshir^*, Adriana Pedraza, Ash Tewari
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
* Corresponding Author: Daniel Ajabshir. Email: email
(This article belongs to the Special Issue: Advances in Microultrasound Imaging for Prostate Cancer)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.079661

Received 26 January 2026; Accepted 20 May 2026; Published online 23 June 2026

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Abstract

Active surveillance (AS) requires reliable imaging to detect grade progression in low-risk prostate cancer. This narrative review evaluates the role of high-resolution micro-ultrasound (micro-US) in AS and its integration with multiparametric magnetic resonance imaging (mpMRI). A targeted synthesis of randomized trials, prospective cohorts, and meta-analyses through December 2025 was performed. The OPTIMUM randomized trial demonstrated non-inferiority of micro-US–guided biopsy for detecting Grade Group 2 or higher cancer. In AS cohorts, micro-US shows high sensitivity (94–97%) and negative predictive value (88–97%) for detecting grade reclassification. These findings support its role as a real-time targeting modality and as a triage tool to reduce unnecessary biopsies, particularly in MRI-limited or discordant settings. Limitations include operator dependence, inter-reader variability, and evolving performance in anterior-zone assessment influenced by training and emerging protocols. Overall, micro-US represents a complementary modality within AS pathways, with ongoing trials expected to define its role in longitudinal surveillance.

Keywords

Active surveillance; micro-ultrasound; prostate cancer; multiparametric magnetic resonance imaging; prostate risk identification using micro-ultrasound; targeted biopsy; grade reclassification

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The role of micro-ultrasound in active surveillance for prostate cancer

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