Prostate cancer diagnosis depends on histopathological verification of cancer tissue. Collection of biopsies is therefore a crucial part of the diagnostic work-up in men with suspected prostate cancer.
However, collecting tissue from the correct region of the prostate is difficult. We will therefore image patients using a multiparametric MRI-protocol and use these images as a guide for a real-time MRI-guided biopsy collection procedure. Using an MR-compatible device, biopsies are collected when the patient is in the MR scanner. The exact position of the biopsy needle can be monitored in the MR images, and it is therefore possible to guide the needle to the most suspicious areas in the prostate for collection of tissue.
In most other cancers, medical imaging procedures are widely used for staging and risk assessment of the disease. In prostate cancer, however, medical imaging currently plays a limited role. St. Olavs University Hospital recently received a hybrid PET/MRI scanner (the only of its kind in Norway). By combining advanced MRI with a novel radiotracer (FACBC), we will evaluate the role of PET/MRI both in primary diagnosis and follow-up of prostate cancer patients.
Many patients with prostate cancer have indolent disease, meaning they may not need any treatment throughout their lifetime. Other patients have more aggressive cancer and are at high risk of dying from their disease. However, a large fraction of patients fall in a category where the prognosis is unclear.
Therefore, there is a need for new biomarkers that can help us identify patients with very good prognosis (these should not receive more treatment than necessary) and very poor prognosis (who need closer follow-up). Our approach is to study the metabolism of tumours using high-resolution magic angle spinning magnetic resonance spectroscopy (HR MAS MRS). Since the metabolism of cancer cells is abnormal, we will look for metabolic profiles containing prognostic information.