New AI tool could reshape prostate cancer care by identifying those at higher risk of rapid disease progression

Researchers at the Icahn School of Medicine at Mount Sinai have developed an advanced artificial intelligence (AI)-driven tool to improve the management and prognosis of prostate cancer. Details on the findings were reported in European Urology.

Recent progress in AI, especially with advances in deep learning techniques, has accelerated the creation of new technologies that use medical images to predict diseases more accurately.

The tool, PATHOMIQ_PRAD, designed for patients with intermediate-risk prostate cancer, uses deep learning to extract morphological features from datasets derived from biopsy or surgical hematoxylin- and eosin-stained whole-slide images. It aims to identify those at higher risk of rapid disease progression and provide more timely, accurate predictions for earlier interventions and more targeted, personalized, treatment plans. Estimates for prostate cancer in the United States for 2024 are about 299,010 new cases, with about 35,250 deaths.

“About 60% of patients in the intermediate-risk group don’t have a clear treatment plan, and around 30 to 50% see their cancer progress after the first round of therapy. We’re finding that some of these patients are at higher risk for rapid progression, so identifying them early is critical,” says co-corresponding author Ash Tewari, MD, MBBS, MCh, Kyung Hyun Kim, MD Professor and Chair of the Milton and Carroll Petrie Department of Urology at Icahn Mount Sinai.

“We developed this tool to analyze samples from biopsies or surgeries, providing a clearer understanding of which patients may require more aggressive treatment earlier to improve their outcomes. PATHOMIQ_PRAD has the potential to become a routine part of clinical decision-making.”

PATHOMIQ_PRAD scores range from 0 to 1, with higher scores indicating high-risk features. The study analyzed large datasets to classify patients into high- and low-risk groups using pre-determined PATHOMIQ_PRAD clinical cut offs of 0.45 for BCR and 0.55 for metastasis. These limits were based on things like the chances of cancer returning or spreading. The study found that the tool outperformed existing benchmark cancer outcomes over the next five years compared to other current tools.

“One key advantage of the tool is its ability to analyze specific regions of tissue that may hold clues to previously undiscovered drivers of prostate cancer progression. This insight could potentially lead to advancements in understanding racial disparities in prostate cancer outcomes, helping us explore why certain populations face more aggressive disease,” says co-corresponding author Sujit S. Nair, Ph.D., Assistant Professor and Director of GU Immunotherapy Research in the Department of Urology at Icahn Mount Sinai.

“These developments are exciting, and we are working toward further validation studies.”

The Icahn Mount Sinai researchers worked in collaboration with PATHOMIQ INC., based in Cupertino, California, to develop PATHOMIQ_PRAD. Next, the researchers plan to conduct large-scale clinical validation studies with a more diverse patient population. They also aim to pursue regulatory approval to develop PATHOMIQ_PRAD as a Lab Developed Test, allowing its use in CLIA-certified labs.

Additionally, the Icahn Mount Sinai and PATHOMIQ teams are integrating the tool with advanced genomic profiling techniques, such as spatial transcriptomics and mass cytometry, to enhance understanding of the biology behind the regions identified by PATHOMIQ_PRAD.

“Our study pioneers an innovative design, and we’re thrilled about the AI tool’s potential to transform risk stratification for prostate cancer patients, paving the way for future advances,” says Rachel Brody, MD, Ph.D., Professor of Pathology, Molecular and Cell-Based Medicine at Icahn Mount Sinai and a co-author of the study.

“This study highlights the clinical potential of this innovative AI tool, which uses digitized whole-slide images to transform prostate cancer of Urology at Icahn Mount Sinai.”

“Ours is the first AI tool designed for intermediate-risk prostate management. By analyzing various tissue types—epithelial, stromal, and immune cells—it generates a detailed score for each patient, predicting outcomes and offering a powerful new way to guide treatment decisions,” says co-corresponding author Dimple Chakravarty, Ph.D., Assistant Professor of Urology at Icahn Mount Sinai.

“[The AI tool] is both scalable and generalizable. It can be used for risk stratification from biopsy and surgery specimens. It’s affordable, quick, and adaptable for use in various health care settings.”