Prospective Comparison of Cognitive MRI-Targeted Biopsy Under Micro-Ultrasound Guidance Versus MRI/Ultrasound Fusion-Guided Transperineal Biopsy for Clinically Significant Prostate Cancer Detection

Background/Objectives: Multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy has become central to prostate cancer (PCa) diagnosis. While cognitive and software-based fusion targeting have already been compared, the use of high-resolution micro-ultrasound as a real-time guidance platform for cognitive translation of MRI-defined lesions remains incompletely characterized. This study prospectively compared mpMRI-transrectal ultrasound (TRUS) fusion-guided transperineal (TP) biopsy with cognitive MRI-targeted TP biopsy under real-time ExactVu® micro-ultrasound guidance.