The new AI test identifies prostate cancer patients who will benefit from abiraterone

The new AI test identifies prostate cancer patients who will benefit from abiraterone

A new artificial intelligence (AI) test can determine which men with prostate cancer will benefit most from life-extending drug abiraterone in clinical trial results from scientists at UCL and the Institute of Cancer Research.

Researchers analyzed prostate cancer tumor samples from men with high-risk prostate cancer that had not spread who participated in the Stampede study. Using the new AI test, they found that abiraterone given along with standard hormone therapy almost stopped the risk of death for approximately 25% of men with this type of cancer.

However, because many men do well with standard therapy, those who would get the most benefit need to choose better.

Experts say NHS England should review the decision not to fund treatment for this group of men because fewer men than previously thought are thought to need the drug.

The natural history of advanced and aggressive prostate cancer varies greatly and now the risk of cancer recurrence can be significantly reduced. This study demonstrates that, in a very large cohort of patients, novel AI algorithms can be used to extract information from routinely available pathology slides to tailor these treatments to specific patients and minimize overtreatment while maximizing the probability of cure. “

Professor Gert Attard, co-leader of the study from the UCL Cancer Institute

Abiraterone, discovered at the Institute of Cancer Research (ICR) in the UK, inhibits the production of the hormone testosterone in all tissues throughout the body, including tumors.

It is approved for patients with advanced prostate cancer that has returned and spread to other parts of the body, but not for the 8,400 men a year with newly diagnosed high-risk prostate cancer that has not yet spread. However, it has been available to men with this indication in Scotland and Wales for two years.

The new test, developed by Artera Inc., uses AI to examine images of tumor samples and spot features that are invisible to the human eye.

Researchers used the test on biopsy images from more than 1,000 men who took part in the Stampede trial. Patients received a score – either biomarker positive or biomarker negative – which was compared to the results of their disease.

In patients with biomarker-positive tumors, abiraterone reduced the risk of death from 17% to 9% after five years.

For people with biomarker-negative tumors, the risk of death without abiraterone was 7%, which was reduced to 4% with abiraterone - a difference that was not statistically or clinically significant. These men would therefore benefit from standard therapy alone and could avoid unnecessary treatment and additional side effects that come with it.

Professor Nick James, co-leader of the study from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, said: "Abiraterone has already significantly improved the outlook for hundreds of thousands of men with advanced prostate cancer. We know that for many men with cancer that has not yet spread, it increases the risk of diabetes and heart attacks, so it is very valuable to know who is most likely to benefit.

“This research shows that we can select the people who respond best to abiraterone and those who do well from standard treatment alone - hormone therapy and radiotherapy.

"Access to this life-sustaining drug is currently a postcode - with those living in Scotland and Wales able to receive the treatment free of charge. The NHS in England has previously decided it would be too expensive to offer the drug. With the patent expiring in 2022, the abiraterone costs just £77. Cost to purchase.

Dr. Matthew Hobbs, research director at Prostate Cancer UK, said: "Stampede has made a huge improvement in prostate cancer treatment over the last decade. However, we recognized that the samples and data from men in the study were an untapped resource and an opportunity to deliver the kind of precision treatment that will benefit patients with other cancers for years to come.

"To realize this potential, Prostate Cancer UK, in collaboration with Movember, has awarded £1.4m to gain a more accurate understanding of prostate cancer, including the use of AI tools. Today's results show that our strategic investment is now delivering exactly what we aim for: tools that identify men most likely to benefit.

"Prostate Cancer UK has been calling on the UK government to approve this life-saving, cost-effective drug for over two years. These exciting results suggest an opportunity to make this an even more cost-effective approach. We therefore reiterate to the researchers' commitment to Abiraterone, whose lives it can now be made available to men thanks to this research, more precisely than ever."

Giles Turner, 64, who lives in Brighton, was diagnosed with prostate cancer in March 2023. He has been taking Abiraterone for almost two years and has so far spent £20,000 on his treatment. He said: "This is great research and adds even more reasons for NHS England to fund this treatment now. I find it very difficult to come to terms with paying for this treatment whilst on the NHS in Scotland or in Scotland or in Wales.

The study results were presented at the American Society of Clinical Oncology (ASCO) 2025 Annual Meeting. This current research received funding from Artera Inc., UK Medical Research Council and Prostate Cancer UK. The Stampede trial is coordinated by the Medical Research Council (MRC) Clinical Trials Unit at UCL and funded by Cancer Research UK.

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