IMAGING IN RISK ASSESSMENT OF PROSTATE CANCER PATIENTS

与女性乳腺癌一样，前列腺癌也是美国男性的主要公共卫生问题。改善这种疾病结果的主要障碍之一是目前缺乏对如何准确确定疾病进展风险的了解。如果没有这些信息，就很难做出明智的决定，决定哪种类型的治疗最合适，或者是否需要任何治疗。虽然在前列腺癌文献中有许多研究评估了使用标准病理终点进行预分期的影像诊断的准确性，但关于影像预测肿瘤侵袭性或患者预后的能力的数据很少。这项拟议研究的广泛、长期目标是通过明智地使用诊断成像测试来改善前列腺癌患者的治疗，以准确地对疾病进行分期，并帮助确定疾病进展的风险。我们提议的研究调查了一种可能的新的肿瘤危险因素，它可以与现有的危险因素结合使用，以提供比目前可能的更准确的肿瘤侵袭性评估。我们希望验证这样一种假设，即磁共振成像提供的形态(MRI)和代谢(MRSI)信息可以比单独使用临床危险因素更准确地确定肿瘤侵袭性和预测患者预后。我们研究的具体目的是：1.确定MRSI确定的前列腺癌区域代谢异常的严重程度是否代表了一种重要的新的肿瘤侵袭性的独立衡量标准。2.比较MRSI、MRI和TRUS在确定前列腺癌根治术患者局部肿瘤范围方面的准确性。3.确定将从MRSI、MRI、TRUS和临床风险因素获得的诊断信息相结合的最佳方式，以提供比单独使用任何诊断测试更准确的风险评估。

Like breast cancer in women, prostate cancer is a major public health concern in American men. One of the major roadblocks to improving the outcome of this disease is a current lack of understanding of how to accurately determine the risk of disease progression. Without this information, it is difficult to make an informed decisions about what type of treatment is most appropriate, or whether any treatment is needed at all. Although there are many studies in the prostate cancer literature evaluating the diagnostic accuracy of imaging for pretreatment staging using standard pathologic endpoints, there is little data on the ability of imaging to predict tumor aggressiveness or patient outcomes. The broad, long-term objective of this proposed research is to improve the treatment of patients with prostate cancer by the judicious use of diagnostic imaging tests to accurately stage the disease and to help determine the risk of disease progression. Our proposed research investigates a possible new tumor risk factor, which may be used in conjunction with existing risk factors to provide a more accurate assessment of tumor aggressiveness than is currently possible. We wish to test the hypothesis that the morphologic (MRI) and metabolic (MRSI) information provided by MR imaging allows more accurate determination of tumor aggressiveness and prediction of patient outcome than the use of clinical risk factors alone. The specific aims of our study are to: 1. Determine whether the severity of abnormality in metabolism in areas of prostate cancer identified by MRSI represents a significant new independent measure of tumor aggressiveness. 2. Compare the accuracy of MRSI, MRI, and TRUS in determining the local extent of tumor in patients who will undergo radical prostatectomy. 3. Determine the best way to combine the diagnostic information obtained from MRSI, MRI, TRUS, and clinical risk factors to provide more accurate risk assessment than the use of any diagnostic test alone.