How to cite: Cole AJ. “The Role of Pathologists in Planning.” Grand Rounds in Urology. November 2025. Accessed Jan 2026. https://grandroundsinurology.com/the-role-of-pathologists-in-planning
Summary
Adam J. Cole, MD, Founder and CEO of TruCore Pathology, Little Rock, Arkansas, discusses how pathologists contribute to treatment planning through detailed morphologic review and the integration of predictive artificial intelligence (AI) tools. He presents a case of a 59-year-old man with a low prostate-specific antigen and mixed-grade disease on biopsy. Careful examination revealed cribriform glands and neuroendocrine-like features, prompting an upgrade from Gleason 3+4=7 to 4+5=9, changing the clinical approach from surveillance to active intervention.
Dr. Cole explains how digital pathology and AI can now predict molecular alterations such as PTEN or BRCA2 loss directly from standard H&E slides. In a TruCore validation study of 23 prostate cancer cases, AI-predicted PTEN loss closely matched immunohistochemical staining, even when tumor involvement was limited to a small focus. This capability could help triage which specimens warrant confirmatory testing or genomic sequencing.
He emphasizes that these technologies do not replace pathologists but instead provide a quantitative second opinion that complements expert human review. The challenge ahead lies in delivering AI results in a clinically useful and interpretable format that integrates seamlessly into reports for urologists and oncologists.
Dr. Cole stresses that the evolving role of pathologists now bridges traditional histopathology with data-driven prediction. By combining diagnostic precision with validated computational tools, pathology can play a decisive role in advancing precision oncology.
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.
