Personalized medicine for prostate cancer is becoming more of a reality for a larger number of men thanks to new precision oncology software. The US Food and Drug Administration (FDA) approved an artificial intelligence (AI) prostate cancer management platform called iQuest. Developed by the AI health care company Avenda Health, the platform supports the patient from initial consultation with the physician through treatment selection, planning, guidance and follow-up.

It has been clinically proven with 97% accuracy in finding the extent of cancer in patients and achieved 72.8% total cancer encapsulation rate compared to only 1.6% with standard of care, according to the company. “There are decision support platforms for radiologists, pathologists, and cardiologists, but nothing for the urologist before,” said Shyam Natarajan, PhD, co-founder and CEO of Avenda Health.

Until now, the main cancer management platform a urologist had access to was the electronic medical record reports, labs, MRI, and pathology, but this information is not integrated into a single cohesive ‘picture’ that is actionable, Dr Natarajan said. “We use AI built on hundreds of thousands of data points to not only integrate disparate pieces of information, but to build a 3D map of cancer,” he said.

MRI cannot identify the full extent of the tumor and cancer growth within the prostate. This has led to the current standard of care with complete removal or irradiation of the entire prostate. The iQuest system combines existing patient-specific diagnostic information and deep-learning algorithms to create a tailored map of where cancer is within the prostate.

Dr Natarajan said the one-size-fits-all approach of treating the entire prostate may soon be changing. The iQuest system personalizes treatment options for the individual patient to preserve quality of life and prevent recurrence. “Providing physicians with a 3D visualization of the cancer offers a better understanding of the extent of the disease to aid in treatment planning that can preserve quality of life while minimizing cancer left behind,” Dr Natarajan said.

Development of iQuest was the culmination of a decade of research. The system was validated in multiple clinical studies. In one study, urologists using iQuest improved the sensitivity of determining tumor extent from 37% to 97% and changed treatment recommendations in 27% of cases, with the biggest change towards more localized treatment, according to the company.

The platform can be applied to multiple treatment options to guide an intervention plan, including the use of FocalPoint (Avenda Health’s soft tissue laser ablation device) as well as other focal treatments. It may provide more information to support active surveillance (AS) or other approaches. Dr Natarajan said iQuest aids the urologist in determining the best course of action for the patient by showing them the likely extent of disease and margin for targeted therapy, which is not possible with the current standard of care.

“Unlike existing AI products, which are primarily used in diagnosis via digital radiology or digital pathology, [iQuest] is aimed towards urologists for use after a patient already has a diagnosis of prostate cancer and a Gleason grade in order to help the physician decide what to do next,” Dr Natarajan said.

One of the key challenges for treatments of localized prostate cancer is in understanding the extent of all clinically significant disease. “MRI and targeted biopsy via fusion do a great job in diagnosing patients and identifying the ‘index lesion’, but do not give the full picture of where disease is within a patient,” Dr Narajaran said.

“This AI technology has the potential to not only identify the location, but perhaps more importantly define the extent of the cancer,” said Marc A. Bjurlin, DO, MSc, Co-director of Clinical Trials at the Lineberger Comprehensive Cancer Center and Associate Professor of Urology at the University of North Carolina in Chapel Hill. “Knowing this information may help with patient selection, but long-term data will be needed to determine improvements in treatment outcomes, including both cancer control and preservation a man’s quality of life.”

Dr Bjurlin, who is participating in an upcoming prostate cancer clinical trial using this AI technology, said an AI management platform may bring greater precision to treatment and result in better tissue sparing. “Urologists may have a better understanding of which patients will benefit from focal therapy, which may need more aggressive treatment whole gland treatment, and which may be candidates for active surveillance and can avoid treatment with its attendant risks,” he said.

William Catalona, MD, Professor of Urology at Northwestern University in Chicago, Illinois, said the new management platform and others in the near future may be useful in a “second-opinion” context. “There are so many variables across demographics, locations, patients, treatments, doctors, pathologists, radiologists, outcome criteria, etc., that this will be very difficult to evaluate robustly,” Dr Catalona said. “The bottom line will be long-term patient outcomes with over 20 years of follow-up.”

Yair Lotan, MD, Chief of Urologic Oncology and Vice-Chair of Clinical Affairs at the University of Texas Southwestern Medical Center in Dallas, noted that AI is being used to change treatment paradigms in urology and other medical disciplines. In light of the hype attendant with some new technologies, he urged clinicians need to be cautious. “Clinical application of AI is an enticing prospective, but we need more information regarding the greater precision or accuracy the AI platform is adding from what you already know from the biopsies and MRI report. Further validation will be needed to evaluate this technology.”