We are leading the development and clinical translation of an extraordinary new molecular imaging technique utilizing hyperpolarized 13C labeled metabolic substrates that has the potential to revolutionize the way we use MR imaging in the risk assessment of prostate cancer patients. Hyperpolarized (HP) 13C MR is a new molecular imaging technique that allows rapid and noninvasive monitoring of dynamic pathway-specific metabolic and physiologic processes. Hyperpolarization, achieved through the dynamic nuclear polarization (DNP) technique, can provide unprecedented gain in sensitivity (10,000 – 100,000 fold increase) for imaging 13C-labeled bio-molecules that are endogenous, nontoxic, and nonradioactive. Metabolically active HP 13C-labeled compounds can be delivered to living systems where the substrate is metabolized and the products can be imaged in real time. The ability to detect down-stream metabolism, specifically the metabolic flux of HP 13C-pyruvate to lactate catalyzed by lactate dehydrogenase (LDH), has shown great potential for not only detecting prostate cancer, but for also assessing the aggressiveness (pathologic grade) of the cancer and response to therapy. The first DNP polarizer for human studies has been sited at UCSF and we have successfully completed the first clinical trial of 13C MR metabolic imaging in patients with prostate cancer. Future trials clinical studies of HP 13C MR in patients with advanced prostate cancer are planned to investigate the clinical value of this technique and new technical developments are underway to allow the assessment of metastatic prostate cancer. Moreover, we have been involved in the translation of this technology to other urologic cancers and diseases and in the development of new hyperpolarized MR probes.