oDigital pathology biomarkers for guiding radiotherapy-based treatment concepts in prostate cancer − a systematic review and expert consensus

Research output: Contribution to journalReview articleContributedpeer-review

Contributors

  • Constantinos Zamboglou - , German Medical Institute (Author)
  • William De Doncker - , German Medical Institute (Author)
  • Andreas Thomas Christoforou - , German Medical Institute (Author)
  • Stefano Arcangeli - , University of Milan - Bicocca (Author)
  • Alejandro Berlin - , Princess Margaret Cancer Centre , University of Toronto (Author)
  • Pierre Blanchard - , Institut Gustave Roussy (Author)
  • Glenn Bauman - , Western University (Author)
  • Riccardo Campi - , Careggi University Hospital (Author)
  • Elena Castro - , Hospital Universitario 12 de Octubre (Author)
  • Ananya Choudhury - , University of Manchester (Author)
  • Alan Dal Pra - , University of Miami Miller School of Medicine (Author)
  • Cédric Draulans - , KU Leuven, AZ Sint-Maarten (Author)
  • Neil Desai - , University of Miami Miller School of Medicine (Author)
  • Konstantinos Ferentinos - , German Medical Institute (Author)
  • Giulio Francolini - , Careggi University Hospital (Author)
  • Silke Gillessen - , Ente Ospedaliero Cantonale (EOC), University of Lugano (Author)
  • Anca Ligia Grosu - , University Medical Center Freiburg, German Cancer Research Center (DKFZ), University of Freiburg (Author)
  • Juan Gómez Rivas - , Hospital Clinico Universitario San Carlos (Author)
  • Tobias Hoelscher - , Department of Radiotherapy and Radiooncology, University Hospital Carl Gustav Carus Dresden (Author)
  • George Hruby - , Royal North Shore Hospital, University of Sydney (Author)
  • Barbara Alicja Jereczek-Fossa - , University of Milan, IRCCS Istituto Europeo di Oncologia - Milano (Author)
  • Sophia Kamran - , Harvard University (Author)
  • Veeru Kasivisvanathan - , University College London, University College London Hospitals NHS Foundation Trust, Alan Turing Institute (Author)
  • Amar U. Kishan - , University of California at Los Angeles (Author)
  • Valentinos Kounnis - , Churchill Hospital (Author)
  • Andrew Loblaw - , University of Toronto (Author)
  • Jarad Martin - , GenesisCare, Newcastle (Author)
  • Federico Mastroleo - , University of Milan, IRCCS Istituto Europeo di Oncologia - Milano, Mayo Clinic Rochester, MN (Author)
  • Axel S. Merseburger - , University Hospital Schleswig-Holstein - Campus Lübeck (Author)
  • Marcin Miszczyk - , Medical University of Vienna, WSB University (Author)
  • Osama Mohamad - , University of Texas MD Anderson Cancer Center (Author)
  • Piet Ost - , Iridium Network (Author)
  • Athanasios Papatsoris - , National and Kapodistrian University of Athens (Author)
  • Jan C. Peeken - , Technical University of Munich, Deutsche Gesellschaft für Radioonkologie (DEGRO), German Cancer Consortium (DKTK) partner site Munich, Helmholtz Zentrum München - German Research Center for Environmental Health (Author)
  • Francesco Sanguedolce - , Autonomous University of Barcelona (Author)
  • Paul Sargos - , Centre Georges-François Leclerc, Amethyst Radiotherapy (Author)
  • Nina Schmidt-Hegemann - , Ludwig Maximilian University of Munich (Author)
  • Tyler M. Seibert - , University of California at San Diego (Author)
  • Mohamed Shelan - , University of Bern (Author)
  • Shankar Siva - , University of Melbourne, Peter Maccallum Cancer Centre (Author)
  • Timo F.W. Soeterik - , Santeon, St. Antonius Hospital (Author)
  • Daniel E. Spratt - , Case Western Reserve University (Author)
  • Arnulf Stenzl - , University of Tübingen (Author)
  • Iosif Strouthos - , European University Cyprus (Author)
  • Philip Sutera - , University of Rochester Medical Center (Author)
  • Stephane Supiot - , Ico Centre René GAUDUCHEAU, Université de Nantes (Author)
  • Derya Tilki - , Stanford University, University of Hamburg (Author)
  • Phuoc T. Tran - , University of Maryland, Baltimore (Author)
  • Alison C. Tree - , Royal Marsden NHS Foundation Trust (Author)
  • Jonathan Tward - , University of Utah (Author)
  • Yüksel Ürün - , Ankara University (Author)
  • Neha Vapiwala - , University of Pennsylvania (Author)
  • Mark R. Waddle - , Mayo Clinic Rochester, MN (Author)
  • Eric Wegener - , GenesisCare, Newcastle (Author)
  • Thomas Zilli - , University of Lugano, Ente Ospedaliero Cantonale (EOC), Geneva University Hospitals (Author)
  • Vedang Murthy - , Homi Bhabha National Institute (Author)
  • Alexander Henry Thieme - , Stanford University (Author)
  • Simon Spohn - , German Cancer Research Center (DKFZ), University Medical Center Freiburg (Author)

Abstract

Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity, and digital pathology (DP) combined with artificial intelligence (AI) tools (DP-AI) may offer a solution to this challenge. The aim of this work is to summarize the role of DP-AI for PCa patients treated with radiotherapy (RT), and to point out future areas of research. We conducted (1) a systematic review on the evidence of DP-AI for patients treated with RT and (2) a survey of experts using a modified Delphi method, addressing the current role of DP-AI in clinical and research practice to identify relevant fields of future development. Eleven studies investigated DP-AI in PCa RT, with most using the multimodal AI (MMAI) classifier and four ongoing studies are currently prospectively testing the DP-AI performance. DP-AI showed strong prognostic and predictive performance for endpoints like distant metastasis free survival and overall survival, outperforming traditional risk models and assisting treatment decisions such as androgen deprivation therapy (ADT) duration. Fifty-one and 35 experts responded to round 1 and round 2 of the survey respectively. Questions with ≥75 % agreement were considered relevant and included in the qualitative analysis. Survey results confirmed growing adoption of DP scanners, although regional differences in re-imbursement mechanisms and availability persist, with experts endorsing DP-AI's potential across localized, postoperative, and metastatic settings, though further prospective validation is needed. DP-AI tools show strong prognostic and predictive potential in various PCa by guiding patient stratification and optimising ADT duration in primary RT. Prospective studies and validation in cohorts using modern diagnostic and treatment methods are needed before broad clinical adoption.

Details

Original languageEnglish
Article number111039
JournalRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Volume210
Publication statusPublished - Sept 2025
Peer-reviewedYes

External IDs

Scopus 105010263448

Keywords

Sustainable Development Goals

Keywords

  • Androgen deprivation therapy, Artificial intelligence, Biomarkers, Digital pathology, Personalized medicine, Prostate cancer, Radiotherapy, Risk stratification, Treatment selection