PCa Commentary | Volume 196 – December 2024
Posted by Edward Weber | December 2024
“MY PROSTATE TEST”
A Risk Stratification Model for Outcome Post Prostatectomy; Eligibility for Active Surveillance; and Relative Benefit of Short-Term ADT Added to Radiation Therapy – all combined in the “ArteraAI Prostate Test”
Given extensive data sets composed of fully defined characteristics of the patients likely to utilize the model, AI can make an accurate outcome prediction for an individual patient. These requirements were met by Spratt et al. in developing the first iteration of “My Prostate Test” by ArteraAI, in their article “Artificial Intelligence Predictive Model for Hormone Therapy in Prostate Cancer,” NEJM Evidence, June 2023.
Their model is a clinically available AI-enabled test (My Prostate Test) to predict the relative benefit of adding short-term hormone suppression to radiation in the primary treatment of prostate cancer. To accomplish this, they integrated the digitized pre-treatment histopathological data, clinical characteristics, and long-term (8 yr) outcome data of 2024 patients with localized cancer from 5 Phase III prospective clinical trials comparing radiation therapy +/- 4 months adjuvant Lupron + an antiandrogen. In the study, 87% had NCCN intermediate-risk cancer (Gleason Score 3+4). The objective was to create a multimodal predictive model to determine the differential relative benefit of combining 4 months of adjuvant ADT with radiotherapy compared to alone in prolonging the time to develop distant metastases.
How does the algorithm work? An illustration Based on Intermediate-Risk Patients
After receiving the digitalized histopathology data from the pre-treatment biopsy slides, ArteraAI applies its algorithm, analyzes the specimen, and evaluates the result with their large database, the repository of outcome records of the 5442 patients in the study, half receiving radiotherapy alone or in combination with ADT. Their algorithm creates a “predictive model” for everyone – either positive or negative.
Results: The men who received radiation (RT) and ADT who were predictive model positive benefited from ADT and experienced a 10-year distant metastasis (DM) estimate of 4% versus 14.4% for those men treated with radiation therapy only. In contrast, within the model negative group, there was no benefit from adding ADT to RT. Both the RT + ADT and the RT alone groups showed comparable 10-year DM rates, 6.9% and 7.4%.
Conclusion: The authors state that their “AI-based predictive model was able to identify prostate cancer patients, with predominantly intermediate-risk disease, who are likely to benefit from short-term ADT.” “Using this predictive model, we showed from the trial data that most intermediate-risk patients did not benefit from ADT.”
Extending “My Prostate Test” to Address High-risk Patients:
Spratt et al., (Eur Urol 2024 Jul) extended the application of My Prostate Test to risk-stratify men with localized high-risk prostate cancer based on the analysis of digitalized histopathology slides of 426 patients from 3 randomized clinical trials. The study included men with clinical stage T-4, Gleason Score 8 – 10, PSA >20 ng/mL, and primary Gleason pattern 5 with a median follow-up of 10.4 years. The study endpoints were the development of distant metastases (DM) and Prostate Cancer-Specific Mortality at 10 years.
Conclusion: Depending on a man’s characteristics the DM outcome raged from 8% for the lower 25% of men in the study to 26% for the highest quartile. As was also the case for men with intermediate-risk cancer, both analyses revealed the wide variation in response to treatment in these conventional NCCN risk groupings. “This scalable tool can provide physicians and patients with more personalized information for shared decision-making on treatment.”
The Latest Addition to “My Prostate Test”:
ArteraAI has expanded” MyProstateTest” to include the prediction of developing distant metastases 10 years after prostatectomy and guidance for men considering active surveillance vs. active treatment. “The prognostic performance of the test has now been validated in a diverse cohort of patients, including those who have undergone active surveillance or radiation therapy or had a radical prostatectomy,” Trevor Royce MD, MPH, medical director of ArteraAI. The new application of the test to active surveillance was based on a study by Esteva et al, “Prostate cancer therapy personalization via multi-modal deep learning on randomized phase III clinical trials.” Their artificial intelligence-based tool employed clinical data and digital histopathology of 5654 biopsies of men followed for a median of 11.4 years and predicted 5-and 10-year biochemical failure and distant metastases, identifying more aggressive disease that would warrant intervention. Their AI risk-stratifying tool was more accurate than the customary NCCN model. “Outfitted with digital scanners and internet access, any clinic could offer such capabilities, enabling global access to therapy personalization.”
To learn more about “My Prostate Test” and how to order a test, search “Advanced AI Prostate Cancer Test.”
Bottom Line: “My Prostate Test” (ArteraAI) provides individualized outcome predictions for prostatectomy, active surveillance, and the efficacy of adjuvant hormone suppression supplementing primary radiation therapy to guide management decisions.
Your comments and requests for information on a specific topic are welcome e-mail ecweber@nwlink.com.
Please also visit https://prostatecancerfree.org/prostate-cancer-news for a selection of past issues of the PCa Commentary covering a variety of topics.
“We appreciate the unfailing assistance of the librarians at Providence/Swedish.”
ABOUT THE AUTHOR
Edward Weber, MD, is a retired medical oncologist living in Seattle, Washington. He was born and raised in a suburb of Reading, Pennsylvania. After graduating from Princeton University in 1956 with a BA in History, Dr. Weber attended medical school at the University of Pennsylvania. His internship training took place at the University of Vermont in Burlington.
A tour of service as a Naval Flight Surgeon positioned him on Whidbey Island, Washington, and this introduction to the Pacific Northwest ultimately proved irresistible. Following naval service, he received postgraduate training in internal medicine in Philadelphia at the Pennsylvania Hospital and then pursued a fellowship in hematology and oncology at the University of Washington.
His career in medical oncology was at the Tumor Institute of the Swedish Hospital in Seattle where his practice focused largely on the treatment of patients experiencing lung, breast, colon, and genitourinary cancer and malignant lymphoma.
Toward the end of his career, he developed a particular concentration on the treatment of prostate cancer. Since retirement in 2002, he has authored the PCa Commentary, published by the Prostate Cancer Treatment Research Foundation, an analysis of new developments in the prostate cancer field with essays discussing and evaluating treatment management options in this disease. He is a regular speaker at various prostate cancer support groups around Seattle.
