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.

主动监测（AS）是一种越来越多应用于低风险前列腺癌患者的治疗选择。然而，据报道，由于在最初诊断时的错误分类，该病的停药率高达20%至60%。传统诊断工具的局限性降低了这种治疗前选择的安全性和依从性。其后果是过度治疗和潜在的并发症或各自治疗的不必要的长期影响。前列腺多参数MRI （mp-MRI）和MRI引导活检是优化患者选择和观察的有前途的工具。MRI可以更好地识别具有临床意义的疾病患者，因此，当mp-MRI为阴性时，有可能排除患有无关紧要疾病的患者进行积极治疗。然而，MRI诊断作为as的一部分的高潜力仍然需要在国家和国际指南中得到验证。为了提高该诊断工具的安全性和可靠性，需要优化单个MRI序列的获取和解释，并将其与活检或前列腺切除术的组织病理学结果相关联。超极化（HP） 13C MR是一种新的分子成像技术，可以快速和无创地监测动态通路特异性代谢和生理过程，并有能力进一步提高MRI检查的有效性。因此，本项目旨在评估mpMRI联合超极化（HP） 13C MR的可靠性，以在主动监测中排除低危前列腺癌患者的显著癌，减少过度治疗和停药患者的数量。

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.