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Multicenter Study
. 2025 Jan:202:110618.
doi: 10.1016/j.radonc.2024.110618. Epub 2024 Nov 6.

Validation of an artificial intelligence-based prognostic biomarker in patients with oligometastatic Castration-Sensitive prostate cancer

Jarey H Wang  1 , Matthew P Deek  2 , Adrianna A Mendes  1 , Yang Song  1 , Amol Shetty  3 , Soha Bazyar  3 , Kim Van der Eecken  4 , Emmalyn Chen  5 , Timothy N Showalter  6 , Trevor J Royce  5 , Tamara Todorovic  5 , Huei-Chung Huang  5 , Scott A Houck  5 , Rikiya Yamashita  5 , Ana P Kiess  1 , Daniel Y Song  1 , Tamara Lotan  1 , Theodore DeWeese  1 , Luigi Marchionni  7 , Lei Ren  3 , Amit Sawant  3 , Nicole Simone  8 , Alejandro Berlin  9 , Cem Onal  10 , Andre Esteva  5 , Felix Y Feng  11 , Phuoc T Tran  12 , Philip Sutera  13 , Piet Ost  14
Affiliations
Multicenter Study

Validation of an artificial intelligence-based prognostic biomarker in patients with oligometastatic Castration-Sensitive prostate cancer

Jarey H Wang et al. Radiother Oncol. 2025 Jan.

Abstract

Background: There is a need for clinically actionable prognostic and predictive tools to guide the management of oligometastatic castration-sensitive prostate cancer (omCSPC).

Methods: This is a multicenter retrospective study to assess the prognostic and predictive performance of a multimodal artificial intelligence biomarker (MMAI; the ArteraAI Prostate Test) in men with omCSPC (n = 222). The cohort also included 51 patients from the STOMP and ORIOLE phase 2 clinical trials which randomized patients to observation versus metastasis-directed therapy (MDT). MMAI scores were computed from digitized histopathology slides and clinical variables. Overall survival (OS) and time to castration-resistant prostate cancer (TTCRPC) were assessed for the entire cohort from time of diagnosis. Metastasis free survival (MFS) was assessed for the trial cohort from time of randomization.

Results: In the overall cohort, patients with a high MMAI score had significantly worse OS (HR = 6.46, 95 % CI = 1.44-28.9; p = 0.01) and shorter TTCRPC (HR = 2.07, 95 % CI = 1.15-3.72; p = 0.015). In a multivariable Cox model, MMAI score remained the only variable significantly associated with OS (HR = 6.51, 95 % CI = 1.32-32.2; p = 0.02). In the subset of patients randomized in the STOMP and ORIOLE trials, high MMAI score corresponded to improved MFS with MDT (p = 0.039) compared to patients with a low score, with pinteraction = 0.04.

Conclusion: The ArteraAI MMAI biomarker is prognostic for OS and TTCRPC among patients with omCSPC and may predict for response to MDT. Further work is needed to validate the MMAI biomarker in a broader mCSPC cohort.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: PTT declares a consulting/advisory role and patent with Natsar Pharmaceuticals (Compounds and methods of use in ablative radiotherapy. Patent filed 3/9/2012. PCT/US2012/028475. PCT/WO/2012/122471) licensed with royalties to Natsar Pharmaceuticals. Consulting/advisory role and research funding with Reflexion Medical and Bayer Health. Consulting/advisory role with Regeneron, Dendreon, Noxopharm, Janssen, Myovant Sciences, AstraZeneca, Pfizer, Lantheus. FYF is a consultant for Janssen, Astellas Pharma, Serimmune, Foundation Medicine, Exact Sciences, Bristol-Myers Squibb, and Varian Medical Systems; advisor and stock options at Artera Inc; stock options for serving on the advisory boards from BlueStar Genomics and SerImmune. APK receives research funding from Advanced Accelerator Applications/Novartis (Inst), Merck (Inst), Bayer (Inst), Novartis Pharmaceuticals UK Ltd. PO reports a relationship with Janssen, Advanced Accelerator Applications, Curium, Bayer and MSD that includes: consulting or advisory. Piet Ost reports a relationship with Bayer and Varian that includes: funding grants. EC, TNS, TJR, TT, H-CH, SAH, RY, and AE are employed by Artera Inc. All remaining authors have declared no conflicts of interest.

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