Background/Objectives: Multiparametric MRI (mpMRI) is widely established as the standard imaging modality for detecting clinically significant prostate cancer (csPCa), yet it can be limited by cost, accessibility, and the need for specialized radiologist interpretation. Micro-ultrasound (micro-US) has recently emerged as a more accessible alternative imaging modality. This review evaluates whether the evidence base for micro-US meets thresholds comparable to those that led to MRI’s guideline adoption, synthesizes diagnostic performance data compared to mpMRI, and outlines future research priorities to define its clinical role. Methods: A targeted literature review of PubMed, Embase, and the Cochrane Library was conducted for studies published between 2014 and May 2025 evaluating micro-US in csPCa detection. Search terms included “micro-ultrasound,” “ExactVu,” “PRI-MUS,” and related terminology. Study relevance was assessed independently by the authors. Extracted data included csPCa detection rates, modality concordance, and diagnostic accuracy, and were synthesized and, rarely, restructured to facilitate study comparisons. Results: Micro-US consistently demonstrated non-inferiority to mpMRI for csPCa detection across retrospective studies, prospective cohorts, and meta-analyses. Several studies reported discordant csPCa lesions detected by only one modality, highlighting potential complementarity. The recently published OPTIMUM randomized controlled trial offers the strongest individual-trial evidence to date in support of micro-US non-inferiority. Conclusions: Micro-US shows potential as an alternative or adjunct to mpMRI for csPCa detection. However, additional robust multicenter studies are needed to achieve the evidentiary strength that led mpMRI to distinguish itself in clinical guidelines.

Metastatic hormone-sensitive prostate cancer (mHSPCa) presents de novo or represents significant disease progression and requires systemic treatment. However, progression to castration resistance is inevitable. The treatment landscape has evolved with the introduction of intensified systemic therapy, including androgen deprivation therapy (ADT) combined with either androgen receptor signaling inhibitors (ARSIs) or cytotoxic chemotherapy (doublet therapy) or combined therapy with both agents (triplet therapy). Landmark trials such as CHAARTED, STAMPEDE, LATITUDE, ENZAMET, and TITAN have established combination therapies as the standard of care, demonstrating significant overall survival benefits. More recently, triplet therapy—integrating ADT, docetaxel, and an ARSI—has emerged as an effective approach, particularly in high-volume metastatic disease, as supported by ARASENS and PEACE-1. Advances in imaging, such as PSMA PET-CT, have improved disease detection, allowing earlier detection of metastasis and appropriate therapy. Similarly, genomic profiling has enabled biomarker-driven, personalized treatment strategies. The role of treatment of the primary tumor, by either radiation therapy or cytoreductive prostatectomy, in low-volume disease continues to be explored. As novel therapies, targeted agents, and immunotherapies undergo investigation, optimizing treatment selection based on disease burden, molecular characteristics, and patient factors will be essential. The future of mHSPCa management lies in multidisciplinary, precision-based approaches to improve patient outcomes while balancing treatment efficacy and tolerability.

Background: Holmium laser enucleation of the prostate (HoLEP) has emerged as an effective surgical treatment for benign prostatic hyperplasia (BPH). This study evaluated how the adoption of HoLEP in a general urology clinic influenced clinical and procedural volume. Objective: To better understand the practice ramifications of HoLEP adoption, we analyzed the changes to a general urologist’s patient demographics and practice patterns after the addition of HoLEP to their surgical repertoire. Methods: We retrospectively reviewed the electronic health records 30 months before and after the introduction of HoLEP to examine changes in a general urologist’s patient population. Pearson’s Chi-squared test and Student’s t-test were used for statistical analysis. Results: A total of 4390 unique patients were seen over a period of 5-years, with 2052 seen before and 2338 after the introduction of HoLEP. The mean distance from patients’ residence zip codes to the treatment center remained statistically unchanged (pre-HoLEP: 32.52 ± 152.42 miles, post-HoLEP: 29.65 ± 141.79 miles, p=0.9896). Among those who underwent HoLEP, prostate sizes were comparable between patients residing in the same county and those coming from different counties (96.42 ± 3.24 cc vs. 104.52 ± 4.34 cc, p=0.141). Surgical volume rose from 355 to 1018 cases with a concordant increase in other BPH-related surgeries, marked by an inflection point at the time of HoLEP’s introduction. Conclusion: There was an increase in clinical and surgical volume to an established general urologist’s practice after HoLEP was offered. Most patients continued to be drawn from the initial catchment area, potentially reflecting previously unmet treatment needs for patients with large prostate glands.