Advanced ultrasound in prostate cancer care Diagnostic and therapeutic possibilities

Prostate cancer is the most common solid tumor among western men. However, only recently has improving prostate cancer imaging capabilities initiated a transition towards image guided triage, biopsy procedures, therapies and follow-up. This thesis describes this transition, the role for MRI, and foremost: the development of advanced ultrasound for prostate cancer imaging. Contrast enhanced ultrasound allows the detection of microvascular changes associated with prostate cancer. Computer-aided parametric analysis can be employed to facilitate interpretation. The research in this thesis shows these techniques can be used to predict biopsy outcome, to actively target lesions in biopsy procedures and to localize tumors within the prostate using prostatectomy specimens as the reference standard. Furthermore, a 3D registration technique that facilitates matching pathology and imaging results is presented. Contrast enhanced ultrasound can be combined with other modalities such as b-mode and elastography into multiparametric ultrasound. The promise is improved discriminatory power although the available literature is scarce. Focal therapy is a treatment strategy in which only the prostate zone harboring the tumor is treated. The prospect is oncological control with reduced side effects. A Delphi-consensus project is conducted to achieve standardization in definitions and outcomes in focal therapy research. Lastly, this thesis describes the preliminary experience with ablation zone imaging following focal therapy using irreversible electroporation.