In a large number of men in whom prostate cancer has been newly discovered, the standard evaluations in current clincal practice primarily serve as a counseling tool regarding the probability of their tumor being a specific pathologic stage, rather than as a strict decision-making tool for the individual. Key elements for guiding appropriate treatments in the individual include, distinction of organ-confined disease from extracapsular extension (ECE), a determination of total tumor burden and a determination of tumor grade, none of which are satisfactory accomplished in today's pre-treatment paradigm. A more comprehensive and objective means to characterize prostate cancer after its detection and prior to therapy would be very useful for clinical practice. This proposal introduces 3T endorectal coil MRI, both for structure and function, to provide a non-invasive pre-treatment tool that can 1) detect extra-capsular spread, 2) detect and quantify specific areas within the prostate that harbor cancer, 3) determine the aggressiveness of the cancer. The imaging strategy we are proposing acquires higher-resolution images with smaller voxel sizes than has been possible with prior MR technology and more comprehensive tissue sampling compared to other pre- surgical assessments. The results of pre-operative T2-weighted imaging, dynamic contrast-enhanced 3D imaging and MR spectroscopy will be compared to whole mount pathology specimens. Our long-term goal is to provide a non-invasive, pre-treatment evaluation of patients with prostate cancer that can more fully characterize the disease to assist clinicians in their efforts to more objectively and rationally select appropriate treatments. Furthermore, such a capacity can aid in the assessment of new treatment strategies and has the potential to assist in the management of important clinical scenarios such as: a) patients electing a 'watchful waiting'approach to their disease and b) those patients with elevated PSAs and repeat negative biopsies. Ultimately, we hope to further improve the numbers and percentage of cancers that receive curative therapy and maximize the quality of life during and following therapy.
