Prostate Cancer Imaging

Division Of Basic Sciences - Nci

Investigators

Linked publications, trials & patents

Abstract

The prostate imaging team has made substantial progress over the past year. Building on the prior development of MRI-US fusion biopsy which was invented in our laboratory, we now use MRI to direct a variety of potential therapies or adjuvants. We recently completed the 16th patient on a protocol for focal treatment of prostate cancer using transurethral high intensity focused ultrasound. This enable the focal ablation of a cancer without requiring surgery, radiation or androgen deprivation therapy (ADT). Only one patient has recurred which is a far lower recurrence rate than typically associated with focal therapy (~30%). In another development we finished a trial using Biolen which uses MRI to implant ADT eluting seeds within the prostate tumors. This helps the patient avoid systemic ADT in combination with radiation therapy, thus reducing the side effects. In addition Enolin implants with enzalutamide implants were shown to deliver high doses of the drug to the tumor with minimal doses around the tumor. The patients do have surgery as part of this protocol and the tissue is harvested to measure drug amounts in and near the tumor. In addition to these interventional trials (which take place in the Molecular Imaging Clinic) we conduct a number of screening protocols described below. Some patients develop prostate cancer at an early age and it can progress to metastatic disease. Some of these patients present with metastatic disease. Over the past several years we have recruited patients with known genetic mutations associated with cancer formation. Over 350 such individuals and their family members have been recruited for early prostate cancer screening. Approximately 25% of these patients have been shown to have clinically significant prostate cancers. We have also investigated the role of Polygenic Risk Scores (PRS) in such patients. We are currently evaluating PRS scores in 300 patients in this trial and should have a good indication whether this test helps predict patients with an increased risk of developing aggressive prostate cancer. In addition to this study we participate in several trials addressing detection of prostate cancer in high risk groups so that we can change the trajectory of their disease from lethal to curable. Our group was a pioneer in the use of PSMA PET scanning for prostate cancer using it long before it was approved by the FDA. We have and continue to conduct numerous studies in the value and meaning of PSMA scanning. For instance, we concluding a 200 patient study in patients with high risk cancers and showed approximately 15% of them had findings prior to prostatectomy. We continue to be at the forefront of using this type of scan for following patients. For instance, we are conducting a trial of patients with positive PSMA scans who elect not to have immediate treatment and follow these patients with PSMA scans. Over 130 patients have been recruited to this study to date. This study is likely to indicate that positive PSMA scans do not require immediate treatment. Our group has pioneered the use of Artificial Intelligence (AI) in the diagnosis of prostate cancer by MRI. We have developed highly successful algorithms that show the radiologist where the lesion is. Other algorithms can objectively assess scan quality which is a major limitation of MRI. These algorithms have been implemented currently and help NCI radiologists to find lesions that otherwise might have been missed. Since April 2024 the AI findings are shown and biopsies can be performed of AI-detected lesions. In summary, we continue to have a robust clinical prostate imaging program that remains at the state of the art in MRI, interventions and PET scanning. We are eager to develop systems that detect significant prostate cancer earlier where a cure is still possible but also address patients with more advanced disease by applying modern imaging and theranostic methods to improve outcomes in men with this disease.