A new international study has shown that a new imaging method called micro-ultrasound (microUS) is just as effective as MRI in diagnosing prostate cancer—while being faster, cheaper, and more accessible.
This breakthrough could change how prostate cancer is detected and improve access to care for many men worldwide.
The results come from the OPTIMUM trial, the first large-scale randomized study comparing microUS-guided biopsy to the current standard, MRI-guided biopsy. The trial included 677 men across 19 hospitals in Canada, the U.S., and Europe.
The findings were presented at the European Association of Urology Congress in Madrid and published in JAMA.
Micro-ultrasound uses high-frequency sound waves to create very detailed images of the prostate, offering three times the resolution of traditional ultrasound. This makes it possible to spot potential tumors with clarity similar to what an MRI scan provides.
Unlike standard ultrasound or MRI, microUS offers real-time imaging during the biopsy procedure and doesn’t require special equipment to fuse images from different scans.
Participants in the trial were divided into three groups:
- One group received only MRI-guided biopsies
- Another received microUS followed by MRI-guided biopsies
- The last group had microUS-guided biopsies only
The researchers found that all three approaches detected prostate cancer at very similar rates. MicroUS alone was just as effective in identifying significant prostate cancers, including in the group that also received MRI. This confirms that microUS is a strong alternative to MRI-guided biopsy.
Every year, around one million prostate biopsies are performed in both the U.S. and Europe, and 100,000 in Canada. Most use MRI fused with conventional ultrasound to guide the biopsy needle.
But MRI-guided biopsy involves multiple steps and hospital visits: one for the MRI scan and another for the biopsy. It also requires specialized staff to interpret and fuse the images—resources that are not always readily available.
By contrast, microUS allows imaging and biopsy to happen in one appointment. It doesn’t involve any radiation or contrast dye, which can be risky for some patients. And because it’s portable and easier to use, it could be used in outpatient clinics or smaller hospitals—even in rural or lower-resource settings where MRI access is limited.
Professor Laurence Klotz, lead researcher of the study and a surgeon at the University of Toronto, explained the impact:
“When MRI came along, it was a game-changer because it let us target prostate tumors more accurately. But MRI has limits—it’s expensive, hard to access, and not safe for all patients. Now, we know that microUS gives us the same accuracy without those downsides. It opens the door for faster, cheaper, and more accessible care.”
Professor Jochen Walz, a leading urology imaging expert from France, praised the study, noting that the simplified process of microUS reduces the chance of errors, especially those that can occur when transferring images from MRI to ultrasound during fusion-guided biopsies.
He added that although training is needed to interpret microUS images correctly, once learned, the method could revolutionize how and where prostate cancer is diagnosed. “This could be particularly useful in healthcare systems where MRI access is very limited,” he said.
The OPTIMUM trial offers compelling evidence that micro-ultrasound could become a practical, cost-saving alternative to MRI in prostate cancer diagnosis. The benefits are clear: real-time imaging, no need for multiple appointments, broader accessibility, and the potential to free up MRI machines for other uses.
Importantly, microUS doesn’t require any contrast agents, making it safer for patients who can’t undergo MRI due to implants or allergies. Its portability and lower cost also make it promising for use in less developed healthcare systems or rural areas.
However, the success of this method depends on proper training. Clinicians must learn to recognize specific patterns on microUS images that indicate cancer. With training, this technique could be quickly integrated into clinical practice and screening programs, potentially improving early detection and outcomes.
Further research will be needed to confirm microUS’s usefulness for large-scale screening, but for now, the results are promising: prostate cancer diagnosis may soon become quicker, cheaper, and more widely available—without sacrificing accuracy.
If you care about prostate cancer, please read studies about 5 types of bacteria linked to aggressive prostate cancer, and new strategy to treat advanced prostate cancer.
For more information about prostate cancer, please see recent studies about new way to lower risk of prostate cancer spread, and results showing three-drug combo boosts survival in metastatic prostate cancer.
The research findings can be found in JAMA.
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