AI rewrites the script on androgen deprivation therapy in prostate cancer

Artificial intelligence is showing promise in reshaping treatment decisions for men undergoing radiation therapy and androgen deprivation therapy (ADT) for prostate cancer.

While ADT remains a cornerstone of prostate cancer management for men receiving radiotherapy, its toxicities make accurate patient selection critical. Clinical parameters alone have fallen short, underscoring the demand for enhanced risk stratification methods to ensure patients are neither over- nor undertreated.

GenesisCare Radiation Oncologist, Dr Eric Wegener, presented the interim results of the ASTuTE clinical trial at ESTRO earlier this month, focusing on the role of AI in short-term ADT decision-making.

At the heart of the trial is the ArteraAI-Prostate Test, an AI-powered clinicopathological biomarker that offers both prognostic and predictive insights on the benefit of short-term ADT.

The interim analysis included 200 patients, of whom 150 were classified as NCCN unfavourable intermediate risk (UIR) and 50 as favourable intermediate risk (FIR). The AI biomarker revealed a median ten-year prognostic risk of distant metastases at 2.6% for UIR and 1.7% for FIR, differences that were statistically significant (p<0.001).

Critically, the predictive biomarker identified only 15% of patients as potentially benefiting from short-term ADT, with similar proportions across FIR (14%) and UIR (15%) subgroups.

But the most striking result was how the AI data transformed clinical decision-making.

Of the patients who initially agreed to short-term ADT before biomarker results, 70.3% reversed their decision following the AI analysis. Conversely, only 2.4% of patients who initially declined short-term ADT opted to proceed after seeing the biomarker results. These changes were statistically significant (p<0.001), and in total, 85.5% of final decisions were in alignment with the AI test results.

“The ArteraAI-Prostate-Test significantly impacted shared ST-ADT decision-making, with >70% of patients who initially elected for ST-ADT ultimately avoiding it,” the authors said.

As the ASTuTE trial continues to accrue clinical trial participants, future analyses will delve deeper into long-term outcomes including quality of life, toxicity reduction, cost-effectiveness, and treatment efficacy.

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