Evaluation of MRI-controlled transurethral ultrasound therapy for the treatment o

描述（由申请人提供）：与前几十年相比，当代前列腺癌筛查方法导致检出低至中危疾病的男性比例增加，平均检出年龄降低。不幸的是，目前的检测方法主要基于活组织检查，对前列腺体积的不到1%进行采样，并且提供的关于腺体内癌症的确切位置和大小的信息很少。因此，局限性前列腺癌的治疗针对整个前列腺，这在消除疾病方面是有效的，但使许多男性在性、泌尿和肠道功能方面出现长期并发症。近年来，MRI诊断成像已经发展到可以看到前列腺内肿瘤的位置和大小的程度。此外，在图像引导下治疗前列腺癌的新方法的开发提供了更精确治疗的希望，并有可能减少并发症。在本提案中，将评估MRI控制的经尿道超声治疗局限性前列腺癌的能力。该技术涉及使用插入尿道的装置输送的高强度超声能量治疗（通过高温）前列腺中的特定区域。这种治疗的独特之处在于它完全在磁共振成像仪内进行，该成像仪在加热期间提供前列腺内温度的非侵入性图像。这种加热和温度监测的集成使得能够非常精确地治疗腺体内的组织。本研究的总体目标是将局限性前列腺癌的治疗转化为微创门诊手术，与当前治疗一样有效，但并发症要低得多，本研究的目标是评估MRI控制的经尿道超声治疗有效治疗诊断MRI检测到的局限性前列腺癌的能力。这项研究将在计划进行手术的男性中进行，因此可以在切除后研究他们的前列腺，以评估治疗的有效性。这项研究设计是必要的，以确保安全评估这项新技术，这是我们小组最近首次在人类身上进行测试。如果成功，拟议的研究将证明这项技术能够有效地治疗前列腺癌，为未来将这项技术与现有的局部前列腺癌治疗方法进行比较的研究铺平道路。 公共卫生相关性：由于PSA检测的广泛采用，大多数患有前列腺癌的男性在疾病发展的早期阶段被诊断出来，并且年龄较小。常规治疗低至中等风险的局限性前列腺癌是有效的，但留下许多男性性，泌尿和肠道功能的长期损害。这项研究的目标是开发一种微创的、图像引导的治疗局部前列腺癌的方法，这种方法与根治性治疗一样有效，但对生活质量的不良影响减少。鉴于惰性疾病的高患病率和传统治疗方法的高发病率，这种治疗将对大部分接受前列腺癌治疗的男性的生活质量产生显著的积极影响。

DESCRIPTION (provided by applicant): Contemporary screening methods for prostate cancer have resulted in an increase in the proportion of men detected with low- to intermediate-risk disease, and a decrease in the average age of detection, compared to previous decades. Unfortunately, current detection methods largely based on biopsy, sample less than 1% of the volume of the prostate and provide little information about the exact location and size of the cancer within the gland. As a result, treatments for localized prostate cancer target the entire prostate gland, which is effective at eliminating disease, but leaves many men with long-term complications to sexual, urinary, and bowel function. Diagnostic imaging with MRI has advanced in recent years to the point where it is possible to see the location and size of tumours within the prostate gland. In addition, the development of new ways to treat prostate cancer under image-guidance offer the promise of more precise treatments with the potential for reduced complications. In this proposal, the ability of MRI-controlled transurethral ultrasound therapy to treat localized prostate cancer will be evaluated. This technology involves treatment (through high temperatures) of specified regions in the prostate gland using high-intensity ultrasound energy delivered from a device inserted into the urethra. The unique feature of this treatment is that it is performed entirely within a magnetic resonance imager, which provides non-invasive images of the temperature within the prostate during heating. This integration of heating and temperature monitoring enables very precise treatment of tissue within the gland. The overall goal of this research is to transform the treatment of localized prostate cancer into a minimally- invasive, outpatient procedure that is as effective as current treatments, but has much lower complications associated with it. The goal of this proposal will be to evaluate the ability of MRI-controlled transurethral ultrasound therapy to effectively treat localized prostate cancer detected with diagnostic MRI. This study will be performed in men scheduled for surgery, so their prostate glands can be studied after removal to evaluate the effectiveness of the treatment. This study design is necessary to ensure a safe evaluation of this novel technology which was tested recently for the first time in humans by our group. If successful, the proposed study will demonstrate the ability of this technology to be used to treat prostate cancer effectively, paving the way for future studies comparing this technology with existing treatments for localized prostate cancer. PUBLIC HEALTH RELEVANCE: Due to widespread adoption of PSA testing, the majority of men with prostate cancer are diagnosed at earlier stages of disease development, and at a younger age. Conventional treatments for low- to intermediate-risk localized prostate cancer are effective, but leave many men with long-term impairment of sexual, urinary and bowel function. The goal of this research is to develop a minimally-invasive, image-guided treatment for localized prostate cancer that is as effective as radical treatments, but with reduced adverse quality of life effects. Given the high prevalence of indolent disease and the high morbidity of conventional treatment approaches, this treatment would have a significant positive impact on the quality of life of a large proportion of men treated for prostate cancer.