MRI-targeted fusion-guided prostate cancer diagnostics - strategies to avoid overdiagnosis and overtreatment

MRI 靶向融合引导前列腺癌诊断 - 避免过度诊断和过度治疗的策略

• 批准号: 252770640
• 负责人: Professor Dr. Boris Hadaschik
• 金额: --
• 依托单位: Abteilung Radiologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2014
• 资助国家: 德国
• 起止时间: 2013-12-31 至 2016-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/252770640?language=en
• 关键词: MRI; targeted; fusion; guided; prostate

Prostate cancer (PC) is a leading cause of cancer-related morbidity and mortality in men. PC diagnosis is dependent on prostate biopsy. However, standard transrectal ultrasound-guided random biopsies may miss clinically important tumors and they also result in cancer detection in men who are unlikely to benefit from the diagnosis. Due to widespread adoption of PSA-testing, there is an eightfold difference between incidence- and mortality-rates in developed countries. While high risk tumors are still often detected too late, at the same time overdiagnosis and overtreatment of large numbers of biologically insignificant low risk tumors represent important clinical and economical problems.The optimal management of localized PC is critically dependent on an accurate assessment of the individualized risk of tumor progression within the lifetime of the patient. Although active surveillance should nowadays be the treatment of choice for indolent disease, still up to 40% of men shift to active therapy early during their active surveillance due to reclassification towards higher risk disease. To safely increase widespread use of active surveillance, PC diagnostics need to be refined in order to correctly identify aggressive disease from the start.Evidence is accumulating that multiparametric magnetic resonance imaging (mp-MRI) can be used to improve the performance of prostate biopsy. In this context we have developed a novel prostate biopsy system, which fuses pre-interventional MRI-data with peri-interventional ultrasound for image-guided transperineal prostate biopsies. This platform enables accurate examination of all regions of the prostate and exact targeting of cancer-suspicious lesions. The first goal of this proposal is to validate the efficacy and accuracy of mp-MRI and MRI-targeted fusion-guided prostate biopsies to detect clinically significant cancers as compared to specimen obtained by radical prostatectomy as reference standard. Furthermore, we aim to prospectively optimize image-guided prostate biopsy protocols and numbers of cores needed to reduce overdiagnosis of indolent tumors without underdetecting aggressive disease.Using novel 3D-image-guided tissue sampling we want to achieve unprecedented diagnostic accuracy. The results of this proposal will increase patient safety and further individualise the management of PC patients. Ultimately, they will be valuable to prevent overdetection and overtreatment of men with indolent disease.

前列腺癌（PC）是男性癌症相关发病率和死亡率的主要原因。 PC 诊断依赖于前列腺活检。然而，标准经直肠超声引导的随机活检可能会漏掉临床上重要的肿瘤，并且还会导致不太可能从诊断中受益的男性检测到癌症。由于 PSA 检测的广泛采用，发达国家的发病率和死亡率之间存在八倍的差异。虽然高风险肿瘤仍然常常发现得太晚，但同时对大量生物学上不显着的低风险肿瘤的过度诊断和过度治疗代表了重要的临床和经济问题。局部PC的最佳管理关键取决于对患者一生中肿瘤进展的个体化风险的准确评估。尽管现在主动监测应该成为惰性疾病的首选治疗方法，但由于重新分类为高风险疾病，仍有高达 40% 的男性在主动监测期间尽早转向主动治疗。为了安全地扩大主动监测的广泛使用，需要改进 PC 诊断，以便从一开始就正确识别侵袭性疾病。越来越多的证据表明，多参数磁共振成像 (mp-MRI) 可用于提高前列腺活检的性能。在此背景下，我们开发了一种新型前列腺活检系统，该系统将介入前 MRI 数据与围介入期超声相融合，用于图像引导经会阴前列腺活检。该平台能够准确检查前列腺的所有区域并精确定位可疑癌症病变。该提案的第一个目标是验证 mp-MRI 和 MRI 靶向融合引导前列腺活检的有效性和准确性，以检测临床上显着的癌症，并与根治性前列腺切除术获得的样本作为参考标准进行比较。此外，我们的目标是前瞻性地优化图像引导前列腺活检方案和所需的核心数量，以减少惰性肿瘤的过度诊断，同时又不会漏检侵袭性疾病。使用新型 3D 图像引导组织采样，我们希望实现前所未有的诊断准确性。该提案的结果将提高患者安全并进一步实现 PC 患者的个性化管理。最终，它们对于防止对患有惰性疾病的男性进行过度检测和过度治疗非常有价值。