Early Detection of Clinically Significant Prostate Cancer Using Ultrasonic Acoustic Radiation Force Impulse (ARFI) Imaging
Abstract
Rationale: Prostate cancer (PCa) is the second most common cancer in men in the United States, with over 220,000 cases newly diagnosed and over 27,000 deaths annually. The current standard of care for prostate cancer diagnosis is to perform ultrasound guided biopsies in specific locations in the prostate. However, because prostate cancer does not have a unique appearance in ultrasound, these biopsies are not targeted to regions that look like cancer. As a result, these biopsy procedures can miss, leading to an incorrect diagnosis. Many men with prostate cancer have multiple separate biopsy procedures before finding it. Another problem is that cancer often occurs in multiple places in the prostate, and the current biopsy approach does not necessarily find the most aggressive cancer in the prostate. We have preliminary data supporting the hypothesis that the 3D ARFI imaging biopsy targeting system we propose to develop will enable visualization of the most aggressive cancer in the prostate. Our system uses ultrasound to make pictures of how stiff tissues are and provides different information than normal ultrasound images. Therefore, the system will be low-cost and can be easily incorporated into urology clinics where biopsies are normally performed. If successful, our system will enable first-time biopsy procedures to be targeted toward the most aggressive cancer in the prostate. Aims: There are three specific aims. In the first aim, we will translate our preliminary sequences and processing methods to an ultrasound system that will be able to process the data in real time, so that as each image is acquired we can display the results. In the second aim, we will develop 3D visualization tools to enable reviewing the entire prostate volume data as soon as the last image plane is obtained (9 minutes for the entire sequence), and to allow the clinician to identify the target, automatically align the real-time imaging plane with the target, and perform the biopsy of this region. In this second aim, we will demonstrate the system s functionality using tissue-mimicking materials. In the third aim, we will perform a pilot clinical study of 30 patients in which we determine how well our system performs in targeting and biopsying the most aggressive cancer in the prostate. Clinical Translation: This system will be ready for in-clinic use upon completion of this work, as will be demonstrated by the pilot clinical study in Aim 3. If successful, the sequences and algorithms can be readily integrated into commercial ultrasound systems, thus providing rapid translation to the commercial market. The time to translation for our hepatic fibrosis staging system was less than 5 years, which we anticipate will be similar for the proposed 3D prostate ARFI imaging system. Impact: This work has the potential to change the way prostate cancer is diagnosed and to guide more informed treatment decisions, by detecting the most aggressive cancer in the prostate upon first-time biopsy procedures. It may also reduce the required number of biopsy cores as compared to the current standard. It could also benefit patients electing to pursue active surveillance or focal therapy by providing a low-cost, highly specific imaging modality to identify and monitor the progression of disease.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610653
Entities
People
- Kathryn R. Nightingale
Organizations
- Duke University
- United States Army