Abstract
Recent developments in diagnostic imaging herald a new approach to diagnosis and management of prostate cancer. Multimodality fusion that combines anatomic with functional imaging data has surpassed either of the two alone. This opens up the possibility to “find and fix” malignancy with greater accuracy than ever before. This is particularly important for prostate cancer because it is the most common male cancer in most developed countries. This article describes technical advances under investigation at our institution and others using multimodality image fusion of magnetic resonance imaging (MRI), transrectal ultrasound (TRUS), and PSMA PET/CT (defined as the combination of prostate-specific membrane antigen [PSMA], positron emission tomography [PET], and computed tomography [CT]) for personalized medicine in the diagnosis and focal therapy of prostate cancer with high-intensity focused ultrasound (HiFUS).
Highlights
In the United States, prostate cancer is the third most common cause of cancer death, with 161,360 new cases and 26,730 deaths expected in 2017.1 Worldwide 1,111,700 cases and 307,500 deaths are attributed to prostate cancer.[2]
While the incidence of prostate cancer spiked from about 1980 to 2000 due to prostate-specific antigen (PSA) blood test screening, recently the rates have declined dramatically because screening with PSA is no longer recommended for men of average risk.[3]
This report will focus on the fusion of ultrasound (US), magnetic resonance imaging (MRI), and prostatespecific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) to detect clinically significant organconfined prostate cancers, biopsy these target lesions, and institute focal therapy
Summary
In the United States, prostate cancer is the third most common cause of cancer death, with 161,360 new cases and 26,730 deaths expected in 2017.1 Worldwide 1,111,700 cases and 307,500 deaths are attributed to prostate cancer.[2]. This report will focus on the fusion of ultrasound (US), MRI, and PSMA PET/CT to detect clinically significant organconfined prostate cancers, biopsy these target lesions, and institute focal therapy. The situation is analogous to the adoption of lumpectomy and radiation as breast-conserving surgery for breast cancer that occurred in the late 1980s in place of radical mastectomy in women.[5] By sparing normal tissue, this “male lumpectomy” (i.e. focal therapy) reduces the risk of complications and accelerates recovery. One such focal therapy is high-intensity focused ultrasound (HiFUS). Looking further forward, future multi-center randomized controlled trials comparing focal therapy to standard treatment with radical prostatectomy are needed to document equivalence or superiority of focal therapy before its widespread adoption can be recommended
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