Comparative Evaluation of Multipara-metric Magnetic Resonance Imaging and Micro-Ultrasound for the Detection of Clinically Significant Prostate Cancer

Prostate cancer remains one of the most prevalent malignancies among men worldwide, necessitating accurate and early detection of clinically significant disease to guide appropriate management. In recent years, imaging modalities such as multiparametric magnetic resonance imaging (mpMRI) and micro-ultrasound (micro-US) have emerged as valuable tools in the diagnostic pathway. This review provides a comprehensive analysis and comparison of mpMRI and micro-US in identifying clinically significant prostate cancer. mpMRI, incorporating T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced sequences, has demonstrated high sensitivity and standardized reporting through PI-RADS, improving lesion localization and risk stratification. Conversely, micro-ultrasound offers real-time, high-resolution imaging with enhanced spatial detail, enabling targeted biopsy using the PRI-MUS protocol without the need for contrast agents. The review critically evaluates diagnostic accuracy, sensitivity, specificity, cost-effectiveness, accessibility, and operator dependency of both modalities. Additionally, emerging evidence on combined and complementary use is discussed. While mpMRI remains the current reference standard, micro-ultrasound shows promising potential as a cost-effective and accessible alternative. Further large-scale, multicenter studies are required to establish standardized protocols and validate long-term clinical outcomes.