How to cite: Cole AJ. Next Generation Pathology: AI and Precision Oncology. Grand Rounds in Urology. November 2025. Accessed Jan 2026. https://grandroundsinurology.com/next-generation-pathology-ai-and-precision-oncology/
Summary
Adam J. Cole, MD, FS, Founder and CEO, TruCore Pathology, Little Rock, Arkansas, explores the evolution of diagnostic technology from the Gleason system to prostate-specific antigen (PSA) testing, genomics, and artificial intelligence (AI). He traces this progression through key milestones: the introduction of the Gleason grading system in the 1960s, followed by PSA testing in the 1980s, genomic classifiers in the 2010s, and AI pathology platforms in the 2020s.
Dr. Cole highlights the ArteraAI platform, now FDA-authorized and included in National Comprehensive Cancer Network (NCCN) guidelines. The algorithm combines histomorphology with clinical variables such as PSA and T stage to generate a predictive and prognostic risk score. Compared to the NCCN models, ArteraAI enhances the prediction of distant metastasis, biochemical recurrence, and overall survival. Dr. Cole describes how the ArteraAI signature also predicts response to androgen deprivation therapy (ADT) and doublet therapy. In retrospective analysis of the STAMPEDE trial, patients with high-risk features and the AI signature benefited from abiraterone plus ADT, while those lacking the signature did not.
Transitioning to bladder cancer, Dr. Cole reviews Vesta, a Valar Labs computational histology test that evaluates immune activation and stromal composition. The model predicts BCG response and can guide early selection of intravesical chemotherapy for non-responders. He notes its accuracy even after BCG exposure, where histology is often distorted.
Dr. Cole discusses additional AI applications in the pathology workflow. Platforms such as Alpenglow use three-dimensional fluorescence imaging to scan entire biopsy cores without cutting, allowing AI to map glandular structure, angiogenesis, and immunostain profiles. These tools can enhance grading consistency and recurrence prediction beyond the capabilities of traditional two-dimensional microscopy.
Dr. Cole highlights that AI-driven pathology will soon enable whole-core analysis, multimodal prediction, and real-time decision support, creating a more efficient and precise diagnostic ecosystem for both urologists and pathologists.
ABOUT THE AUTHOR
Adam Cole, MD, FS, is the founder and Chief Executive Officer of TruCore Pathology in Arlington, Texas. He is a board-certified Pathologist with a focus in Genitourinary and Molecular Pathology and serves in the United States Air Force Reserves as a Lieutenant Colonel and Squadron Commander of the 44th AMDF/301FW at Eglin Air Force Base.
Dr. Cole earned a bachelor’s degree in Microbiology at the University of Arkansas in Fayetteville, where he graduated with honors. Following this, he completed his master’s degree in Health Science at Duke University in Durham, North Carolina. He earned his medical degree in Anatomic and Clinical Pathology from Louisiana State University Health Sciences Center in Shreveport, and completed his residency in Pathology at the University of Arkansas for Medical Sciences.
In 2015, Dr. Cole partnered with Lumea to develop a more robust pathology process. By utilizing digital pathology and propriety sampling techniques, he discovered that more tissue could be preserved while improving cancer detection, reducing turnaround times and simplifying genomic testing. As active surveillance becomes more prevalent and guidelines from the National Comprehensive Cancer Network (NCCN) continue to evolve, Dr. Cole continues to be a leader in this field.
