Researchers have developed a groundbreaking artificial intelligence test that can predict which men with prostate cancer will benefit most from abiraterone, a drug that can halve the risk of dying from the disease. The AI tool analyzes tumor images to identify features invisible to the human eye, enabling doctors to personalize treatment and avoid unnecessary side effects for patients unlikely to benefit.
The study, conducted by scientists from the Institute of Cancer Research (ICR) in London and University College London, examined data from more than 1,000 men with high-risk prostate cancer that had not spread. The findings will be presented at the American Society of Clinical Oncology Annual Meeting in Chicago.
AI Identifies Key Patient Population
The AI test successfully identified approximately 25% of men with high-risk prostate cancer who possess a particular biomarker that makes them more receptive to abiraterone treatment. For these biomarker-positive patients, taking abiraterone alongside standard hormone therapy dramatically reduced their risk of death after five years from 17% to 9% – a reduction of 47%.
In contrast, men without the biomarker saw their death risk drop from only 7% to 4%, a difference that researchers determined was not statistically or clinically significant. This finding suggests these patients would benefit from standard therapy alone and could be spared the additional treatment burden.
"This research shows that we can pick out the people who will respond best to abiraterone, and those who will do well from standard treatment alone – hormone therapy and radiotherapy," said Professor Nick James, who co-led the research at the ICR and serves as a consultant clinical oncologist at the Royal Marsden NHS foundation trust.
Treatment Implications and Cost Considerations
Abiraterone works by inhibiting testosterone production throughout the body, including in tumor tissue. The drug costs just £77 for a month's supply since its patent expired, making it significantly more affordable than newer cancer treatments that cost thousands of pounds.
However, abiraterone does come with side effects and requires additional monitoring for potential issues including high blood pressure, liver abnormalities, and slightly increased risks of diabetes and heart attacks. The ability to identify patients most likely to benefit becomes particularly valuable given these considerations.
"Abiraterone has already hugely improved the outlook for hundreds of thousands of men with advanced prostate cancer," James noted. "We know that for many men with cancer that has not yet spread, it can also have spectacular results. But it does come with side-effects and requires additional monitoring, so knowing who is most likely to benefit is very valuable."
Regulatory and Access Challenges
Currently, abiraterone is approved for NHS use in England for patients with advanced prostate cancer that has returned and spread to other parts of the body. However, it is not funded for the approximately 8,400 men annually diagnosed with newly diagnosed high-risk prostate cancer that has not spread.
The drug has been more widely available to men in Scotland and Wales for two years. Researchers argue that because fewer men than previously thought will need the drug, NHS England should review its decision not to fund the treatment for those who could benefit earlier.
"I truly hope that this new research – showing precisely who needs the drug to live well for longer – will lead to NHS England reviewing their decision not to fund abiraterone for high-risk prostate cancer that has not spread," James said. The treatment could potentially help 2,100 men annually who would be identified as likely to benefit from the AI test.
Technical Innovation and Future Impact
The AI test, developed in collaboration with Artera Inc and funded by Prostate Cancer UK, the Medical Research Council, and Artera, represents a significant advancement in precision oncology. The technology uses artificial intelligence to study biopsy images and extract information from routinely available pathology slides.
Study co-leader Professor Gert Attard of the UCL Cancer Institute explained: "This study shows, in a very large cohort of patients, that novel algorithms can be used to extract information from routinely available pathology slides to tailor these treatments to specific patients and minimise over treatment whilst maximising the chance of cure."
Dr. Matthew Hobbs, director of research at Prostate Cancer UK, described the AI test as "exciting" and echoed the researchers' call for abiraterone to be made available to men whose lives it can save.
An NHS spokesman responded: "Abiraterone continues to be routinely funded by the NHS in England for several forms of advanced prostate cancer in line with clinical guidance, and we are keeping this position under close review."
