New promising tendencies for updating prostate cancer management algorithm. 3d vector modeling guided approach for biopsy and treatment planning

2 Abdullaiev R.Ya., 1 Mukhomor O.I., 1 Bubnov R.V.
1 Clinical Hospital ”Pheophania“ of State Affairs Department, Kyiv
2 Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

Key words : three-dimensional modeling, ultrasonography, prostate cancer, prostate biopsy, Histoscanning, CT, MRI, sonoelastography, stereoscopy, personalized medicine, EPMA.

Background. Oncology statistics show a steady increase of of prostate cancer occurance, which is ahead of such diseases as lung cancer and stomach cancer in men. Details of some reputable medical records of several industrialized countries indicate the alarming spread of the malignancy. Obviously the early diagnosis and adequate treatment are crucial for a complete cure of the patient. There are known various imaging techniques of diagnosis the prostate cancer. At present we are urged to expand algorithm with novel technologies according to consideration for personalized treatment. We previously developed algorithm for of three-dimensional modeling, based on data integration from different sources of visual information, in particular with radiology and ultrasound image computed for diagnostics and model-assisted interventions [1]. Three-dimensional modeling of premanipulative planning allows use individually tailored invasive techniques with a high level of safety for the patient.

Purpose . The aim of study was to review of new tendencies for prostate cancer including HistoScanning™ and the integrated application of three-dimensional modeling based on the expert segmentation of ultrasonography and radiology data combined with sonoelastography US guided 10-point biopsy protocol and evaluate novel techniques enhanced protocol for prostate cancer diagnosis and treatment planning.

Materials and Methods. In clinical hospital "Pheophania" we apply the prostate cancer diagnostic algorithm, that includes finger study, the PSA test, transrectal ultrasound (TRUS) with sonoelastography identification stiff foci mostly in peripheral zones and following 10-point biopsy guided by ultrasound. We perform US using transrectal multifrequency probe with sonoelastography of Hitachi Hi Vision 900 and for biopsy biplane transrectalprobe of “BK” equipment with BARD and Cook biopsy system were used. The integrated three-dimensional modeling using segmentation of ultrasound CT and MRI data was applied according to own method [1].

Results and discussion. Extending protocol with sonoelastography showed increasing the rate of cancer detection. In 142 cases (67%) histologically samples of the material, taken from the sighting area, suspicious for cancer at sonoelastography) adenocarcinoma revealed [2]. We have great expectation by introducing additional application of novel trends like Prostate HistoScanning™ that was reported sensitivity 90%, specificity 70-72%, positive predictive value 83-84%, negative predictive value 80-82% [3], has the ability to identify, locate and estimate volume of prostate cancer (volume threshold for detection lesions > 0.20 mm > 0.50 mm), may aid in planning of diagnostic biopsies, and different treatment modalities. In men with a lesion identified, it may improve targeting, enabling better risk stratification by obtaining more representative cores. Technique may also have a role in identifying men without clinically significant cancer.
The 3D models of the surface reconstruction from an US data were integrated with CT, MRI for creating virtual complex consisting of vector models. The created vector models (*.stl) have a special value for model guided interventions, radiation therapy planning, mostly for brachytherapy. We use models to improve diagnostics of prostate pathology, by tumor robustness analysis by novel sophisticated technique [5]. We apply anaglyph stereoscopy in imaging finding it as the best modality for visual data representation [4].

Conclusions. Using novel integrated model /ultrasonic assisted algorithm have to be an effective tool for prostate cancer detection, can improve the quality of diagnosis is non-invasive, accessible and informative method and can be used for educational and scientific purposes. Further studies should be promising. Using simulation methods developed in information-dependent interventional radiology and miniinvasive surgery is necessary to introduce a model-guided medicine and making intelligent decisions in diagnosis and therapy.

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2. Mukhomor O. I., Bubnov R. V., Abdullaev R. Ya. Sonoelastography enhanced US guided biopsy for prostate cancer detection // Матеріали науково-практичної конференцiї «Променевi методи дослiдження як дiагностичний та лiкувальний супровiд в онкологiї» Київ: 2012, С.133-134.
4. Пат. № 67883 U, Україна. Спосіб стереоскопічних зображень біомедичних об'єктів МПК (2012.01) A61B 8/00 A61H 39/00 A61B 8/14 (2006.01) G09B 23/30 (2006.01) G09B 23/28 (2006.01) / Бубнов Р.В., Кисельова О.Г – 12.03.2012, бюл. № 5 , 2012 р.
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