AO Project
Mapping of Heterogeneity in Early Prostate Cancer

What we do

Our project will use imaging scans and genomics to improve the early detection of high-risk prostate cancer. We are also working to build tools for early detection that reduce the need for repeated invasive biopsies, which can be difficult for a patient.   

Why we do it

About 24,600 Canadian men were diagnosed with prostate cancer in 2022. The good news is that most men have low-risk prostate cancer that does not pose a risk to their health and doesn’t require immediate treatment. These patients will simply be watched by doctors to make sure that nothing changes over time. On the other hand, we want to figure out which men have high-risk prostate cancer early in the diagnosis process and get them treated as soon as possible. That will give them the best chances of living well with their condition. 

How we do it

A recent clinical trial found that using MRI scans to guide where biopsies were taken from was better than the standard method for finding high-risk cancer. The MRI-guided process requires fewer biopsy samples and in turn causes fewer biopsy side effects. However, MRI-guided biopsy can still sometimes miss the more aggressive part of a person’s prostate cancer which could lead to their cancer not being labeled as high-risk when it should have been. We have been working on this problem and have developed a test that uses biopsy samples to detect hidden high-risk cancer. We will use the data from MRI scans with our test on MRI-guided biopsies to try to find new markers for high-risk cancers.

About our Project:

Prostate cancer is an over-diagnosed disease. Most men die with prostate cancer rather than from prostate cancer. Less than 10 per cent of men die within five years, as they have low risk cancers and are monitored. This active surveillance approach only works if we can accurately catch men who have higher risk disease and give them aggressive treatment. The ability to detect high risk disease early improves their survival. Recently, the PRECISE prostate cancer trial demonstrated that MRI-guided targeted biopsy with just a few biopsies was better than a grid pattern of 12 biopsies done with ultrasound in finding aggressive cancer. This means that the previous random sampling of 12 needles could be reduced to fewer regions and be eliminated altogether in some men reducing the biopsy side effects. However, it is recognized that MRI guided biopsy can still miss cancers by sampling the wrong subregion of a cancer leading to misclassified cancers. Driven by these concerns, our group has developed a molecular signature test named “PRONTO”, for use with prostate biopsy specimens showing the ability to detect hidden high-risk disease. 


This project aims to determine if MRI-guided targeted biopsy, together with the PRONTO molecular signature test can better detect hidden, high-risk prostate cancer cases compared to the current method, which involves ultrasound and multiple biopsies and associated risks for patients.

Project Impact:

If successful, the combined PRONTO molecular signature test and an MRI guided biopsy could help ensure that men who have a biopsy and a positive MRI are more accurately identified as having aggressive prostate cancer allowing for improved clinical decision making.


Sarah Barker, PhD
Program Manager, Diagnostic Development

Project team 

Dr. Jane Bayani,

Dr. Melanie Spears

 Dr. James Mainprize
Sunnybrook Research Institute

Dr. Martin Yaffe
Sunnybrook Research Institute

Dr. Masoom Haider
Mt. Sinai Hospital

Dr. Theodorus van der Kwast

Dr. Anne Martel
Sunnybrook Research Institute

Dr. Laurence Klotz
Sunnybrook Research Institute

Dr. David Berman
Queens’ University