Analysis of prostate MRI-fusion guided biopsies databases and comparison with multi centric results in the US to evaluate the value of different MRI-fusion techniques to detect prostate cancer

我的研究项目的主题是关于检测前列腺癌(PCA)的新诊断方法的有效性。根据目前的指导方针，前列腺活检(PBX)和随后的病理检查是确保PCa诊断的关键。但是，PBX有风险和并发症，如出血和感染。因此，应避免不必要的和重复的活检，并应优化组织标本的获取方式，以提高活检的准确性。系统性PBX的原因是PSA值升高(前列腺特异性抗原，PSA)或直肠指诊可疑异常。一种新的靶向活检方法是磁共振成像-融合引导的前列腺活检(MRI-融合活检)。首先，患者接受前列腺核磁共振检查，由放射科医生审查，并由称为PIRADS(前列腺成像-报告和数据系统)的特定分类系统进行评估。之后，你可以在经直肠超声的引导下，对核磁共振显示的可疑病变进行靶向活检。这种方法达到了更好的准确性，增加了发现PCa的可能性。不幸的是，关于MRI检测PCa的敏感性和特异性的数据各不相同。主要的问题是，当核磁共振检查不明显时，你是否可以避免活组织检查。此外，有必要评估MRI在低风险肿瘤(主动监视治疗)治疗和管理中的应用和帮助。MRI前列腺对于前列腺癌局部治疗的重要性还没有得到很好的研究，所以这一范围的任务应该尽快得到治疗。MRI-融合活检可能是靶向活检的未来，但仍有一些问题和问题需要回答。出于这个原因，我想在哈佛医学院布里格姆妇女医院做一个研究奖学金，专注于这个重要的主题，并将我们的结果与美国大数据的结果进行比较。我的研究项目的发现和结果可能会影响未来的指导方针和我们对检测PCa的最佳可能方法的理解。

The topic of my research project is about validation of new diagnostic methods to detect prostate cancer (PCa). According to current guidelines, biopsy of the prostate (PBx) with following pathological examination is obligatory to ensure the diagnosis of PCa. But, PBx has risks and complications, like bleeding and infection. Therefore, unnecessary and repeated biopsies should be avoided and furthermore, the way of gaining tissue samples should be optimized to increase the accuracy of biopsies. Reasons for a systematic PBx are an elevated PSA-value (Prostate-specific antigen, PSA) or a suspicious abnormality in digital rectal examination. A new approach for targeted biopsy is the magnet resonance imaging-fusion guided prostate biopsy (MRI-fusion biopsy). First, the patient gets MRI of the prostate, which is reviewed by a radiologist and valued by a specific classification system called PIRADS (Prostate Imaging-Reporting and Data System). Afterwards you can take - for example guided by transrectal ultrasound - targeted biopsies of the suspicious lesions seen in the MRI. This method reaches a better accuracy and increases the probability of detecting PCa.Unfortunately, data varies concerning sensitivity and specificity of the MRI to detect a PCa. The main question is if you can avoid a biopsy when the MRI is inconspicuous. Furthermore, it is necessary to evaluate the use and help of MRI in treatment and management of low-risk tumors (Active Surveillance therapy). The importance of MRI prostate for the local treatment of PCa isn’t well examined, so this scope of tasks should be treated soon. MRI-fusion biopsy could be the future of target biopsies but there are still problems and questions which should be answered. For that reason, I want to do a Research Fellowship at Brigham and Women’s Hospital, Harvard Medical School, to focus on this important subject and to compare our outcomes with the results of the big US data. The findings and results of my research project could influence future guidelines and our understanding of the best possible way in detecting PCa.