For two decades, PSA testing has been employed routinely in clinical practice. The outstanding success of this approach, with its emphasis on early detection of malignancy, can be judged by one key distinction between today's prostate cancer patient population and that of 20 years ago: today, >70% of prostate cancer patients are diagnosed with asymptomatic, moderately differentiating adenocarcinomas. Despite this accomplishment, prostate cancer remains the second leading cause of cancer death among American men. The diversity of outcomes observed for this >70% of PCa patients who seek treatment for Gleason score 6 and 7 tumors, as determined by tumor morphology, points to an underlying weakness in the evaluation of prostate tumors, and indicates insufficient specificity in their current description. It is likely that tumor aggressiveness, a crucially informative feature that cannot now be assessed without prostatectomy, accounts for the unpredictable outcomes experienced by these patients. For most of them, decisions on treatment must be determined in the absence of information about tumor behavior and aggressiveness, and in spite of the fact that the selected course may prove to be inappropriate. Preliminary studies of high resolution magic-angle-spinning proton magnetic resonance spectroscopy (HRMAS 1HMRS) as a tool for sensitively and quantitatively probing the underlying biology and behavior of prostate tumors have produced significant results. These results support the technique's potential value for prostate cancer diagnosis and treatment planning. This proposal seeks to correlate metabolic profiles of intact prostatectomy tissue, measured by HRMAS 1HMRS, with both prostate tissue histopathological features and the clinical status of individual patients, in order to establish prostate cancer metabolic profiles and to define cancer signatures. It then aims to test the diagnostic efficacy, confirmed by histopathology, of these respective markers for predicting pathological stage and patient clinical status in both prostatectomy specimens and biopsy samples. Finally, it plans to assess longitudinally the prognostic capability of tumor metabolic profiles, independent of histopathology, to predict specific tumor behavior and patient outcome. Relevance: the overall goal of the project is to improve the accuracy of prostate cancer diagnosis, to contribute to the patient well-being, as well as to reduce costs related prostate cancer cares. ? ? ?
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