MR Guided Focal Prostate Therapy

Clinical trials have demonstrated a reduction in prostate-cancer-specific mortality for patients treated with whole-gland radical therapies. However, there is a growing belief among many clinicians that we are over-treating PCa with radical treatments and creating unnecessary morbidity particularly for low-risk disease where patients and physicians want treatments offering excellent tumour control with minimal morbidity. Advances in imaging with the potential to identify all prostate lesions, and improvements in biopsy techniques, have allowed physicians to consider the option of a properly executed focal ablative PCa therapy on rigorously selected patients. This therapy approach could provide definitive management with minimal treatment-related morbidity. Although focal PCa therapy is being used in a few centres, its general acceptance is hampered as current planning and guidance techniques are still susceptible to variability and inaccuracy due to factors such as: inadequate lesion localization, inability to accurately guide the needle delivering the therapy to the target, the patient’s anatomy (pubic arch interference), and anatomical changes during the procedure (e.g., prostate motion). We propose to overcome these limitations by developing a 3D ultrasound-guided trans-perineal focal prostate therapy project through the integration of robotic aids, multi-modality image fusion, and real-time image processing. Our goal is to develop and validate an accurate and precise focal prostate therapy system, which will operate in the bore of an MRI scanner and will include planning with pre-procedural MR image registration, monitoring of the procedure and prostate changes, and optimal needle guidance.