Multiparametric MRI of the prostate in combination with hyperpolarized 13C spectroscopy in active surveillance of patients with low-risk prostate carcinoma as replacement of repetitive biopsy.

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Active Surveillance (AS) is an increasingly applied therapy option for patients with low-risk prostate cancers. However, due to misclassification at initial diagnosis of the disease high discontinuation rates of 20% to 60% are reported. The limitations of conventional diagnostic tools reduce safety and compliance of this pre-treatment option. The consequences are overtreatment and potential complications or unnecessary long-term effects of the respective treatments. Multiparametric MRI (mp-MRI) of the prostate and MR-guided biopsies are promising tools to optimize patient selection and observation during AS. MRI allows better identification of patients with clinically significant disease and, consequently, has the potential to rule out patients with insignificant disease from active treatment when mp-MRI is negative. However, the high potential of MRI diagnostic as part of AS still needs to be verified to be implemented in national and international guidelines. To increase safety and reliability of this diagnostic tool acquisition and interpretation of single MRI sequences need to be optimized and correlated with histopathological results from biopsy cores or prostatectomy. Hyperpolarized (HP) 13C MR is a new molecular imaging technique that allows rapid and noninvasive monitoring of dynamic pathway-specific metabolic and physiologic processes and has the capability to further increase validity of the MRI examination. Therefore this project aims to evaluate the reliability of mpMRI in combination with Hyperpolarized (HP) 13C MR to rule out significant cancer in patients with low-risk prostate cancer in Active surveillance and reduce overtreatment and the number of discontinuing patients.