Clinical and biological validation of hyperpolarised MRI of prostate cancer
type: CreativeWork
description: Prostate cancer (PCa) is the commonest male malignancy, with the global burden of disease expected to double by 2020. While the introduction of serum prostate-specific antigen testing has led to overdiagnosis of indolent disease, more than half of patients continue to present with locally advanced and/or metastatic PCa. Consequently, there is a pressing need to develop accurate diagnostic tools to detect and characterise clinically significant disease. The recent international adoption of pre-biopsy magnetic resonance imaging (MRI) as the first-line investigation in patients with suspected PCa has created a paradigm shift in PCa diagnostic pathway. With its negative predictive value above 90%, pre-biopsy MRI halves the number of unnecessary biopsies and significantly reduces over-detection of indolent disease. However, MRI is poor at differentiating indolent from clinically significant lesions, thereby necessitating histopathological confirmation limited by the potential for sampling error and procedure-associated complications. Therefore, improving the diagnostic performance of standard-of-care MRI and its specificity for aggressive disease could reduce the requirement for tissue sampling and associated patient morbidity. Imaging the metabolic alterations that occur during tumour development is a promising approach for improving the diagnostic potential of MRI. Hyperpolarised [1-13C]pyruvate MRI (HP-13C-MRI) is an emerging clinical metabolic imaging technique that can probe the exchange of the hyperpolarised 13C label between pyruvate and lactate, a biochemical reaction traditionally viewed as the metabolic hallmark of aggressive cancers. The first-in-man study of the technique showed increased [1-13C]lactate labelling in PCa areas compared to the benign prostate, with more recent studies highlighting the potential of HP-13C-MRI for tumour grade group differentiation and treatment response assessment. This dissertation builds on these early studies to advance clini…
abstract: Prostate cancer (PCa) is the commonest male malignancy, with the global burden of disease expected to double by 2020. While the introduction of serum prostate-specific antigen testing has led to overdiagnosis of indolent disease, more than half of patients continue to present with locally advanced and/or metastatic PCa. Consequently, there is a pressing need to develop accurate diagnostic tools to detect and characterise clinically significant disease. The recent international adoption of pre-biopsy magnetic resonance imaging (MRI) as the first-line investigation in patients with suspected PCa has created a paradigm shift in PCa diagnostic pathway. With its negative predictive value above 90%, pre-biopsy MRI halves the number of unnecessary biopsies and significantly reduces over-detection of indolent disease. However, MRI is poor at differentiating indolent from clinically significant lesions, thereby necessitating histopathological confirmation limited by the potential for sampling error and procedure-associated complications. Therefore, improving the diagnostic performance of standard-of-care MRI and its specificity for aggressive disease could reduce the requirement for tissue sampling and associated patient morbidity. Imaging the metabolic alterations that occur during tumour development is a promising approach for improving the diagnostic potential of MRI. Hyperpolarised [1-13C]pyruvate MRI (HP-13C-MRI) is an emerging clinical metabolic imaging technique that can probe the exchange of the hyperpolarised 13C label between pyruvate and lactate, a biochemical reaction traditionally viewed as the metabolic hallmark of aggressive cancers. The first-in-man study of the technique showed increased [1-13C]lactate labelling in PCa areas compared to the benign prostate, with more recent studies highlighting the potential of HP-13C-MRI for tumour grade group differentiation and treatment response assessment. This dissertation builds on these early studies to advance clini…
author: Sushentsev, Nikita
language: eng
keywords: Hyperpolarised MRI, Magnetic resonance imaging, Prostate cancer
license: https://www.repository.cam.ac.uk/bitstreams/81168fcb-c148-4cb2-aa5e-054f8d4e421f/download
license: https://creativecommons.org/licenses/by/4.0/
date published: 2023-05-15
date modified: 2026-07-24T01:33:28Z
provider: Cambridge University
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: University of Cambridge

PropertyValue
property ID: DOI
value: 10.17863/CAM.102029