) Prostate cancer represents one of the most significant challenges in medicine and public health. Its increased diagnosis has lead to a virtual epidemic. A growing number of men are choosing to minimize the post treatment side effects. The goal of image-guided treatment is to control the surrounding structures. In the proposed research we plan to apply an interactive MR image-g treatment of localized prostate cancer. We have developed an MR-guided brachytherapy program system. MRI is uniquely suited to imaging the prostate allowing excellent visualization of the, tumor and adjacent tissues. Since this program was introduced there have been significant localization, navigation and delivery of therapy, now used in neurosurgery. We propose to adapt diagnosis and treatment of prostate cancer. The challenge is to increase the information content of intraoperative image data by using multimodal features as well as preserving the interactivity and the 3D real time imaging precise delivery of treatment to maximize tumor control will be achieved and will improve treatment. We will (1) Perform MRI-guided prostate biopsies. The diagnosis and localization of prostate cancer maybe improved by using MRI guidance. We will enroll men suspected of having prostate cancer, for biopsy (n=91); (2) Implement and evaluate a fully integrated delivery system. This system will allow preoperative and intraoperative MR images of the prostate to be available on-line in the operating room. There will be image segmentation and registration methods available which will allow us to use the entire accessible image dataset for MRI-guided Brachytherapy. We will randomize 108 men to treatment with or without the new methods. The results will be compared with two retrospective studies using US and basic MR as guidance. We will develop an MR and CT quality assurance program, (n=80, from the brachytherapy cohort). The overall clinical enrollment will take up to 2 years. Ultimately, our long-term goal is to extend the use of these image guidance modalities (e.g. US) and be adapted for guidance of novel cancer treatments such as the local injection of gene therapy or focal laser or cryoablation. In keeping with our long-term goals and those of the RFA we will conduct this work in collaboration with two industrial partners, namely Daum and Alphatech for the biopsy program and the translation of our techniques to US-guided brachytherapy systems. An ultimate goal beyond the scope of this application is our collaboration with General Electric Medical systems (GEMS) on new MR-guided technical advances and an NSF funded project to develop medical robotics.
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