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

描述（由申请人提供）：与过去几十年相比，当代前列腺癌筛查方法导致低至中等风险疾病男性检测比例增加，平均检测年龄下降。不幸的是，目前的检测方法主要是基于活组织检查，样本不到前列腺体积的1%，并且很少提供关于前列腺内癌症的确切位置和大小的信息。因此，局部前列腺癌的治疗针对的是整个前列腺，这在消除疾病方面是有效的，但会给许多男性的性、尿和肠道功能留下长期的并发症。近年来，磁共振成像的诊断技术已经发展到可以看到前列腺内肿瘤的位置和大小。此外，在图像引导下治疗前列腺癌的新方法的发展为更精确的治疗提供了希望，并有可能减少并发症。在本提案中，将评估mri控制经尿道超声治疗局限性前列腺癌的能力。这项技术涉及到使用高强度超声能量（通过高温）治疗前列腺的特定区域，这种能量来自插入尿道的装置。这种治疗的独特之处在于它完全是在磁共振成像仪中进行的，它提供了加热过程中前列腺内部温度的非侵入性图像。这种加热和温度监测的集成可以非常精确地治疗腺体内的组织。这项研究的总体目标是将局部前列腺癌的治疗转变为一种微创的门诊手术，这种手术与目前的治疗方法一样有效，但并发症要少得多。本提案的目的是评估MRI控制的经尿道超声治疗有效治疗诊断性MRI检测到的局限性前列腺癌的能力。这项研究将在计划手术的男性中进行，因此他们的前列腺可以在切除后进行研究，以评估治疗的有效性。这项研究设计对于确保这项新技术的安全评估是必要的，该技术最近由我们小组首次在人体中进行了测试。如果成功，该研究将证明该技术有效治疗前列腺癌的能力，为未来研究将该技术与现有的局部前列腺癌治疗方法进行比较铺平道路。

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.