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

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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.