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 #
5R01CA158627-02
Application #
8296566
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
2012-07-01
Budget End
2013-06-30
Support Year
2
Fiscal Year
2012
Total Cost
$456,245
Indirect Cost
$137,225
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
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Stephenson, Samuel K; Chang, Edward K; Marks, Leonard S (2014) Screening and detection advances in magnetic resonance image-guided prostate biopsy. Urol Clin North Am 41:315-26
Le, Jesse D; Stephenson, Samuel; Brugger, Michelle et al. (2014) Magnetic resonance imaging-ultrasound fusion biopsy for prediction of final prostate pathology. J Urol 192:1367-73
Le, Jesse D; Huang, Jiaoti; Marks, Leonard S (2014) Targeted prostate biopsy: value of multiparametric magnetic resonance imaging in detection of localized cancer. Asian J Androl 16:522-9
Sonn, Geoffrey A; Chang, Edward; Natarajan, Shyam et al. (2014) Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. Eur Urol 65:809-15
Sonn, Geoffrey A; Natarajan, Shyam; Margolis, Daniel J A et al. (2013) Targeted biopsy in the detection of prostate cancer using an office based magnetic resonance ultrasound fusion device. J Urol 189:86-91
Huang, Jiaoti; Wang, Jason K; Sun, Yin (2013) Molecular pathology of prostate cancer revealed by next-generation sequencing: opportunities for genome-based personalized therapy. Curr Opin Urol 23:189-93
Zong, Yang; Goldstein, Andrew S; Huang, Jiaoti (2013) The molecular basis for ethnic variation and histological subtype differences in prostate cancer. Sci China Life Sci 56:780-7
Marks, Leonard; Young, Shelena; Natarajan, Shyam (2013) MRI-ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol 23:43-50
Moore, Caroline M; Kasivisvanathan, Veeru; Eggener, Scott et al. (2013) Standards of reporting for MRI-targeted biopsy studies (START) of the prostate: recommendations from an International Working Group. Eur Urol 64:544-52

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