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How to cite: Rastinehad AR. Micro-Ultrasound for Prostate Cancer: Promising or Fool’s Errand? Grand Rounds in Urology. October 2025. Accessed Jan 2026. https://grandroundsinurology.com/micro-ultrasound-for-prostate-cancer-promising-or-fools-errand
Summary
Ardeshir R. Rastinehad, DO, Professor of Radiology and Urology, Vice Chairman, Department of Urology, Lenox Hill Hospital, and System Director of Prostate Cancer, Northwell Health, New York, New York, delivers a balanced, evidence-focused review of micro-ultrasound for prostate cancer detection, asking whether this emerging technology represents a meaningful advance or a misplaced diversion. The presentation aims to equip clinicians with a practical understanding of micro-ultrasound physics, PRI-MUS scoring, workflow integration, diagnostic performance, cost, and environmental considerations.
The discussion begins with a technical comparison between conventional transrectal ultrasound and micro-ultrasound. Operating at 29 MHz with a higher crystal density, micro-ultrasound offers markedly improved spatial resolution while maintaining sufficient tissue penetration to visualize anterior prostate lesions. The PRI-MUS scoring system is introduced as an ultrasound-based risk stratification framework analogous to PI-RADS, allowing real-time lesion assessment during biopsy.
Dr. Rastinehad emphasizes the learning curve associated with micro-ultrasound interpretation, noting that sensitivity improves after approximately 20 to 40 cases, while specificity may require 40 to 90 cases. He highlights the importance of image storage within a PACS environment to enable quality review and longitudinal learning, a frequent limitation in office-based ultrasound workflows.
Comparative data between micro-ultrasound and multiparametric MRI are reviewed, including multiple systematic reviews and meta-analyses demonstrating non-inferiority for detecting clinically significant prostate cancer. The OPTIMUM randomized controlled trial is discussed in detail, showing comparable detection rates between micro-ultrasound-based targeting and MRI fusion biopsy, with a modest numerical advantage favoring micro-ultrasound. The role of disease prevalence and cohort characteristics in interpreting these findings is addressed.
Dr. Rastinehad underscores that micro-ultrasound is not a staging modality and does not replace MRI for extracapsular extension assessment, surgical planning, or research protocols. Instead, he advocates for a hybrid approach in which micro-ultrasound improves access, throughput, targeting accuracy, and cost efficiency, while MRI remains essential for staging and complex decision-making.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Ardeshir R. Rastinehad, DO, is Vice Chair of Urology at Lenox Hill Hospital and System Director of Prostate Cancer at Northwell Health in New York City. He previously served as Director of Focal Therapy and Interventional Urologic Oncology and Associate Professor of Urology at Mount Sinai.
Dr. Rastinehad was the first urologist in the United States to be dual fellowship-trained in urologic oncology and interventional radiology. He specializes in the surgical management of prostate, kidney, adrenal, and testicular cancer, and is particularly interested in focal therapy for these diseases. He was the first person to perform a gold nano-particle-directed ablation for localized prostate cancer, using an electromagnetic fusion biopsy system he co-developed.
Dr. Rastinehad’s research has been published in leading national and international medical journals including The Journal of Urology, The Journal of Radiology, Urology, and The British Journal of Urology. He has also authored several book chapters.
