Magnetic Resonance Image-guided interventions have enormous potential to improve and advance the care of men with prostate cancer. However, there are clear limitations with the current methods of both prostate cancer diagnosis and treatment. If non-invasive imaging can identify suspicious tumor foci in the gland with greater specificity, it may be used to direct more accurate prostate biopsies. A non-invasive biomarker of the tumor and its possible recurrence, combined with Prostate Specific Antigen detection methods would be a very powerful alternative to biopsy.

In the realm of therapy, there is increasing demand to define a tumor's biological potential and behavior. By limiting therapies to smaller, more focal areas, we can significantly reduce the side effects. We believe that non-invasive imaging techniques will, in the future, be able to characterize and define the metabolic activity of prostate cancer. When we can use imaging to identify truly indolent cancers, watchful waiting with no therapy may become a more attractive option for many men. More aggressive tumors that require intervention, will allow for greater application of image-based therapies. These may include non-invasive MR Guided focused ultrasound (MRgFUS) thermal ablation, to more targeted radiation treatment (interstitial seed implantation or brachytherapy and IMRT), with dose escalation to the focal lesion(s) or perhaps local gene therapy. We also foresee the adoption of breast cancer- lumpectomy and radiation treatment approach to prostate cancer with focal therapies, such as MRgFUS, to provide local tumor ablation or a "lumpectomy" followed by a lower-dose of external beam radiation to the remainder of the gland.

An increasingly aging population as baby-boomers approachretirement age and continue living longer calls for more efficient and effective clinical care. To approach the challenge of increasing efficiency and demand, imaging of prostate tumors may necessitate a combination of molecular techniques with MRI or other modalities such as PET or optical imaging. Thus, multi-parametric and multi-modal image fusion will be required to truly capitalize on the rich data sets that will be generated in these patients. This integration will require development of summary statistical maps (see projects) and single frame of reference display methods to allow true image based interventions to the target lesion(s).

In preparation for these advances, our objective is to develop a fully integrated image guidance system to allow for accurately targeted prostate interventions. In the short term, we plan to develop these methods for MRI based imaging and MR guided interventions. Through the integration of the results of this project and the work of the robotics program, we hope, in the long run, to integrate MRI based imaging and interventions with other imaging modalities and guidance systems.