Prostate cancer is the most common non-cutaneous cancer and the second most common cause of cancer death in America. The American Cancer Society estimates that in 2005 232,090 new cases of prostate cancer will have been identified. It is also estimated that 30,350 will have died from prostate cancer by the end of this year. The lifetime risk of disease is 16.6% for Caucasian and 18.1% for African-Americans and a lifetime risk of death of 3.5% and 4.3% respectively. The age-adjusted mortality rose an estimated 39% from 1985 to 1997. In the most recently published data the age-adjusted mortality from 1992-2001, was down slightly to 34.5% for all races, suggesting little change in clinical important disease along with an increase in diagnostic sensitivity. Combined with an aging population, these factors have made prostate cancer a major medical and socioeconomic problem. Some of these deaths may be due to inadequate methods of detection while the majority are likely due to inadequate treatment. Failure to control localized disease is linked to eventual progression and death.

Currently there are no reliable methods to detect biologically aggressive tumors and there are many men who have indolent tumors detected that will never reach clinical significance. In the latter case, the significant loss in quality of life from the delivery of standard therapies is not justified. Over the past several years, a number of researchers have defined distinct risk groups for treatment failure within the realm of clinically localized prostate cancer. Intermediate risk patients include men with bulky clinical T2 disease, Gleason grade 7 and/or Prostate Specific Antigen (PSA) levels of 310 and "20ng/ml. It is estimated that this represents approximately 40% of all men diagnosed with prostate cancer, and is thus a very significant number. Within this intermediate risk group, approximately 25% are found on biopsy to have a majority of cores containing cancer, and thus have high volume disease. These men in particular are at greater risk of treatment failure with current therapies. Overall, patients in the intermediate risk category have approximately a 50-60% rate of 5-year biochemical control with radiation or surgery alone. However, in the high volume subset this number drops to 25-30%. Selective use of additional prognosticaids including endorectal coil MRI have aided treatment selection. Given the considerable tumor volume within the prostate, local failure is of great concern in this group. There is mounting evidence that within the intermediate risk category the men with high volume disease in particular would benefit from enhanced local tumor eradication. In 2002, the NIH director, Dr. Zerhouni outlined a plan for prostate cancer research and identified several important challenges, including the following two: "To develop improved methods for detecting and diagnosing pre-malignant and malignant conditions and for better predicting disease progression and response to therapy" and " To accelerate development and validation of optimal treatments that target the molecular and cellular characteristics of prostate cancer." The resultant goals from the same report include "developing imaging technologies to provide non-invasive methods to characterize prostate lesions and to develop computer and mathematical modeling techniques that will improve our ability to diagnose and predict tumor progression using imaging methodologies". The imaging detection, characterization and display during biopsy and treatment form the core of our proposed projects.

A 3D movie illustrating an example of prostate cancer (4.46 MB)