Prostate cancer (CaP) is the commonest internal malignancy in U.S. males, accounting for 192,000 new cases and 27,300 deaths annually. However, CaP also exists in a common, non-fatal, insignificant form which does not cause disease. Up to half of newly diagnosed CaP cases qualify histologically as insignificant, but 90% of men with CaP, serious and not, choose immediate curative therapy. Ability to image cancer within the prostate would help define the important cancers, but presently that ability is lacking. We propose to evaluate an advanced imaging system, the Artemis device, in men undergoing prostate biopsy to exclude malignancy. The device employs digital video processing of conventional ultrasound images to (1) create a contemporaneous 3D reconstruction of the prostate, (2) plan biopsy sites systematically, (3) digitally record the biopsy sites for future re-call, and (4) fuse or superimpose previously-obtained magnetic-resonance imaging (MRI) of the prostate with concurrent ultrasound images in a real-time manner. Potential advantages of this new technology include improved ability to sample the entire prostate thoroughly, to precisely record sampling sites for future re-biopsy, and to directly use images from MRI as well as ultrasound for biopsy targeting. MRI of the prostate, when performed in a multi-modal fashion---3Tesla coil combined with dynamic contrast enhancement and diffusion-weighted imaging---appears to be approaching clinical utility in visualizing cancer within the prostate. In the present study, results obtained with the new imaging system would be compared with (1) findings on whole-mount prostate pathology, for men undergoing prostatectomy (N=350/yr at UCLA), and (2) biopsy findings at diagnosis and subsequently, for men undergoing active surveillance (vast unmet need in Southern California). Accuracy of ultrasound/MRI fusion would be tested by comparing location of fiducial markers in the prostate seen on each of the two modalities. Value of MRI as a biopsy guide would be tested by comparing results of biopsies targeted at suspicious lesions seen on MRI vs 12-core systematic biopsies. The surveillance arm will provide opportunity for longitudinal testing of the imaging device in men with low- risk CaP in a structured, prospective program. Improved imaging and precise biopsy of the prostate, as provided by multi-modal MRI and the Artemis device, may help re-define significant and insignificant cancer.

Public Health Relevance

This project aims to re-define prostate cancer significance through development of the Artemis device, a tool to help visualize and track disease within the organ. By bringing multi-modal MRI to the ultrasound suite, allowing precise imaging, tracking, and targeting of suspicious lesions, the device offers the potential to improve currently available methods of cancer diagnosis. The ultimate goals are to diagnose serious cancers earlier and follow low-risk cancers more accurately than now possible.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
1R01CA158627-01
Application #
8087971
Study Section
Special Emphasis Panel (ZRG1-SBIB-U (55))
Program Officer
Baker, Houston
Project Start
2011-07-05
Project End
2014-06-30
Budget Start
2011-07-05
Budget End
2012-06-30
Support Year
1
Fiscal Year
2011
Total Cost
$487,849
Indirect Cost
Name
University of California Los Angeles
Department
Urology
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Elkhoury, Fuad F; Simopoulos, Demetrios N; Marks, Leonard S (2018) Targeted Prostate Biopsy in the Era of Active Surveillance. Urology 112:12-19
Nassiri, Nima; Chang, Edward; Lieu, Patricia et al. (2018) Focal Therapy Eligibility Determined by Magnetic Resonance Imaging/Ultrasound Fusion Biopsy. J Urol 199:453-458
Elkhoury, Fuad F; Simopoulos, Demetrios N; Marks, Leonard S (2018) MR-guided biopsy and focal therapy: new options for prostate cancer management. Curr Opin Urol 28:93-101
Chang, Edward; Jones, Tonye A; Natarajan, Shyam et al. (2018) Value of Tracking Biopsy in Men Undergoing Active Surveillance of Prostate Cancer. J Urol 199:98-105
Palapattu, Ganesh S; Salami, Simpa S; Cani, Andi K et al. (2017) Molecular Profiling to Determine Clonality of Serial Magnetic Resonance Imaging/Ultrasound Fusion Biopsies from Men on Active Surveillance for Low-Risk Prostate Cancer. Clin Cancer Res 23:985-991
Nassiri, Nima; Margolis, Daniel J; Natarajan, Shyam et al. (2017) Targeted Biopsy to Detect Gleason Score Upgrading during Active Surveillance for Men with Low versus Intermediate Risk Prostate Cancer. J Urol 197:632-639
Felker, Ely R; Raman, Steven S; Margolis, Daniel J et al. (2017) Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary? AJR Am J Roentgenol 209:1272-1277
Priester, Alan; Natarajan, Shyam; Khoshnoodi, Pooria et al. (2017) Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology. J Urol 197:320-326
Stoyanova, Tanya; Riedinger, Mireille; Lin, Shu et al. (2016) Activation of Notch1 synergizes with multiple pathways in promoting castration-resistant prostate cancer. Proc Natl Acad Sci U S A 113:E6457-E6466
Jones, Tonye A; Radtke, Jan Phillip; Hadaschik, Boris et al. (2016) Optimizing safety and accuracy of prostate biopsy. Curr Opin Urol 26:472-80

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