Illuminating the pathway For image-guided prostate cancer care

The aim of this thesis is to improve the diagnostic pathway for prostate cancer (PCa) and to develop a minimal invasive focal ablative treatment for PCa.
In Chapter 2 risk stratification for detection of clinically significant PCa (csPCa) with systematic biopsy in biopsy naive patients with prostate imaging-reporting and data system (PI-RADS) classification ≤2 on pre-biopsy prostate MRI is evaluated, predictors for csPCa are integrated into a novel risk calculator and compared to contemporary risk calculators. Furthermore, in Chapter 3 an optimal biopsy strategy is determined for prostate biopsy patients with a unilateral PI-RADS classification ≥3 on pre-biopsy prostate MRI based on detection rates of csPCa and iPCa using different combinations of MRI-targeted biopsy, ipsilateral and/or contralateral systematic biopsy. Additionally, in Chapter 4 safety and feasibility of needle-based confocal laser endomicroscopy (CLE) for real-time PCa detection is investigated in prostate biopsy patients.
In Chapter 5 safety and feasibility and short-term quality of life outcomes of transperineal focal laser ablation (TPLA) for treatment of PCa under local anesthesia in a daycare setting is evaluated. Moreover, in Chapter 6 three-dimensional ablative effects of TPLA for treatment of PCa are visualized on prostate MRI and contrast-enhanced ultrasound (CEUS) and correlated with whole-mount prostate histology after RARP. Finally, in Chapter 7 safety, feasibility and medium-term oncological and functional outcomes of salvage RARP are studied for recurrent localized PCa following initial focal ablative therapy using irreversible electroporation (IRE).