Prostate cancer is an extremely prevalent disease, resulting in the deaths of over 41,800 men annually in the United States. When prostate cancer is confined to the gland, or is minimally invasive into the seminal vesicles and capsule, it has been conventionally treated by surgical removal. An increasing number of patients are now selecting focal radiation therapies (conformal radiation therapy and Brachytherapy) which have demonstrated lower complication rates without survival disadvantage, and are much less intrusive. Selection of appropriate patients, therapeutic planning, and assessment of therapeutic efficacy of focal radiation therapies requires an accurate knowledge of the location, spatial extent and aggressiveness of the cancer prior to and after therapy. Currently available clinical measures (PSA, histology of biopsies) and non-invasive radiologic techniques (transrectal ultrasound, CT, MRI) often cannot reliably provide this information. The goal of the current proposal is to determine whether the metabolic information provided by 3-dimensional 1H spectroscopic imaging (MRSI) can accurately assess the spatial extent and grade of prostate cancer prior to and after conformal radiation therapy and radioactive seed implantation (Brachytherapy). The feasibility of accomplishing this goal is supported by our experience in performing over 800 MRI/MRSI examinations of prostate cancer patients, the large patient population at UCSF, the direct involvement of radiation oncologists and urologists in the project, and the large amount of preliminary MRSI/MRI data which support the biochemical hypotheses which form the basis of this proposal. Specifically, in a 3-D MRSI study of 85 prostate cancer patients prior to radical resection, we demonstrated that choline and citrate levels could assess the presence and spatial extent of prostate cancer prior to therapy with high specificity. In a recently completed study of 62 pre-radical prostatectomy patients with step section histopathology, we demonstrated for the first time that the addition of MRSI to MRI can significantly improve both cancer staging and localization of cancer within the prostate prior to therapy. There is also preliminary evidence that the magnitude of the changes in choline and citrate are correlated with cancer grade, and that MRSI can discriminate cancer from necrosis and other viable tissues after therapy. However, there has not been to date, a serial prospective MRSI study on a clinically significant number of prostate cancer patients receiving radiotherapy. The data acquired in this proposal should allow us to determine if combined MRI/MRSI can: 1) improve our understanding of the metabolic effects of radiation therapy on normal and malignant prostatic tissues, 2) improve the selection of patients for radiation therapy, 3) aid in therapeutic planning, and 4) allow a early, more quantitative assessment of therapeutic efficacy.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
Project #
Application #
Study Section
Diagnostic Radiology Study Section (RNM)
Program Officer
Stone, Helen B
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Francisco
Schools of Medicine
San Francisco
United States
Zip Code
Zhang, V Y; Westphalen, A; Delos Santos, L et al. (2014) The role of metabolic imaging in radiation therapy of prostate cancer. NMR Biomed 27:100-11
Westphalen, Antonio C; Coakley, Fergus V; Roach 3rd, Mack et al. (2010) Locally recurrent prostate cancer after external beam radiation therapy: diagnostic performance of 1.5-T endorectal MR imaging and MR spectroscopic imaging for detection. Radiology 256:485-92
Joseph, Tim; McKenna, David A; Westphalen, Antonio C et al. (2009) Pretreatment endorectal magnetic resonance imaging and magnetic resonance spectroscopic imaging features of prostate cancer as predictors of response to external beam radiotherapy. Int J Radiat Oncol Biol Phys 73:665-71
Westphalen, Antonio C; Kurhanewicz, John; Cunha, Rui M G et al. (2009) T2-Weighted endorectal magnetic resonance imaging of prostate cancer after external beam radiation therapy. Int Braz J Urol 35:171-80; discussion 181-2
Noworolski, Susan M; Crane, Jason C; Vigneron, Daniel B et al. (2008) A clinical comparison of rigid and inflatable endorectal-coil probes for MRI and 3D MR spectroscopic imaging (MRSI) of the prostate. J Magn Reson Imaging 27:1077-82
Kim, Yongbok; Hsu, I-Chow J; Lessard, Etienne et al. (2008) Class solution in inverse planned HDR prostate brachytherapy for dose escalation of DIL defined by combined MRI/MRSI. Radiother Oncol 88:148-55
Kurhanewicz, John; Vigneron, Daniel B (2008) Advances in MR spectroscopy of the prostate. Magn Reson Imaging Clin N Am 16:697-710, ix-x
Westphalen, Antonio C; Coakley, Fergus V; Qayyum, Aliya et al. (2008) Peripheral zone prostate cancer: accuracy of different interpretative approaches with MR and MR spectroscopic imaging. Radiology 246:177-84
Noworolski, Susan Moyher; Vigneron, Daniel B; Chen, Albert P et al. (2008) Dynamic contrast-enhanced MRI and MR diffusion imaging to distinguish between glandular and stromal prostatic tissues. Magn Reson Imaging 26:1071-80
Hom, Jeffrey J; Coakley, Fergus V; Simko, Jeffry P et al. (2007) High-grade prostatic intraepithelial neoplasia in patients with prostate cancer: MR and MR spectroscopic imaging features--initial experience. Radiology 242:483-9

Showing the most recent 10 out of 23 publications