Simmons, LAM; (2016) Prostate cancer detection and characterisation using innovative medical imaging. Doctoral thesis , UCL (University College London).

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Abstract

Prostate cancer is the second most common cancer affecting men worldwide. All prostate cancer however, is not equal: some forms of the disease are inert and do not require intervention; other, more aggressive forms benefit from early detection and treatment. Thus, accurate risk stratification is paramount. Inadequacies in the current diagnostic pathway for prostate cancer lead to incorrect risk assignment. Ways of enhancing the diagnostic pathway and improving risk stratification using novel bio-markers are being actively researched worldwide. This thesis focuses on work carried out at University College London (UCL)/University College London Hospitals (UCLH), investigating imaging as a biomarker in prostate cancer. The development of an enhanced form of ultrasound imaging - Prostate HistoScanning (PHS), and the use of multi-parametric magnetic resonance imaging (mpMRI) for prostate cancer detection and risk stratification are investigated. The main body of work: Prostate Imaging Compared to Transperineal Ultrasound guided biopsy for significant prostate cancer Risk Evaluation; the acronym for this is the PICTURE Study, was designed and carried out at UCLH between 2012 and 2014. This research aimed to establish if imaging has a role in improving prostate cancer detection and, if by utilizing imaging in the form of either multi-parametric MRI (mpMRI) or prostate HistoScanning (PHS), men with a negative test may be spared further prostate biopsy. Additionally, for men with a lesion detected on imaging, could a targeted sampling strategy afford accurate disease detection and risk stratification. Despite initial promising results, prostate HistoScanning was found to have no role in prostate cancer detection. Multiparametric MRI however, demonstrated high performance characteristics for the detection of disease. It shows potential as a useful tool for men in whom diagnostic uncertainty remains following primary biopsy; it is asserted that it should therefore be used to help risk stratify these men. Moreover, mpMRI targeted biopsy provides accurate risk stratification; and is an approach that should be adopted.

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