A new artificial intelligence (AI) test can identify which men with prostate cancer will benefit most from the life-extending drug abiraterone, in clinical trial results presented by scientists from UCL and the Institute of Cancer Research.
The researchers analyzed prostate cancer tumour samples from men with high-risk prostate cancer that had not spread, who took part in the STAMPEDE trial. Using the new AI test, they found that abiraterone given alongside standard hormone therapy almost halves the risk of death for approximately 25% of men with this type of cancer.
However, since many men do well with standard therapy, there is a need to better select those who would gain the most benefit.
Experts say that because fewer men than previously thought will need the drug, NHS England should review the decision not to fund the treatment for this group of men.
The natural history of advanced and aggressive prostate cancer is highly variable and now with better treatments, the risk of cancer relapse can be significantly reduced. This study shows, in a very large cohort of patients, that novel AI algorithms can be used to extract information from routinely available pathology slides to tailor these treatments to specific patients and minimize overtreatment whilst maximizing the chance of cure."
Professor Gert Attard, co-lead of the trial from UCL Cancer Institute
Abiraterone, discovered in the UK at The Institute of Cancer Research (ICR), works by inhibiting the production of the hormone testosterone in all tissues throughout the body, including in the tumour.
It is approved for use on the NHS in England for patients with advanced prostate cancer that has come back and spread to other parts of the body, but not for the 8,400 men per year with newly diagnosed, high-risk prostate cancer that has not yet spread. However, it has been available for men with this indication in Scotland and Wales for two years.
The new test, developed by Artera Inc., uses AI to study images of tumour samples and spot features that are invisible to the human eye.
The researchers used the test on biopsy images from more than 1,000 men who took part in the STAMPEDE trial. Patients were given a score - either biomarker-positive or biomarker-negative - that was compared to the outcomes of their illness.
For patients with biomarker-positive tumours, abiraterone cut the risk of death after five years from 17% to 9%.
For those with biomarker-negative tumours, risk of death without abiraterone was 7%, which was cut 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 the additional side effects that come with it.
Professor Nick James, co-lead of the trial from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, said: "Abiraterone has already hugely 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 can also have spectacular results. But it does come with side effects and requires additional monitoring for potential issues with high blood pressure or liver abnormalities. It can also slightly increase the risk of diabetes and heart attacks, so knowing who is most likely to benefit is very valuable.
"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.
"Access to this life-extending drug is currently a postcode lottery - with those living in Scotland and Wales able to receive the treatment for free. The NHS in England has previously decided that it would be too expensive to offer the drug. Since the patent expired in 2022, abiraterone costs just £77 per pack - compared with the thousands of pounds that new drugs cost. Previous research by my team has shown that preventing cancer relapses for these men would save more money than the drug costs to purchase. 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 to fund abiraterone for high-risk prostate cancer that has not spread."
Dr Matthew Hobbs, Director of Research at Prostate Cancer UK, said: "STAMPEDE has driven huge improvements in prostate cancer treatment over the past decade. But we recognised that the samples and data from men in the trial represented an untapped resource and a way to deliver the sort of precision treatment we have seen benefiting patients with other cancers for years.
"To unlock that potential, Prostate Cancer UK, in partnership with Movember, awarded £1.4m to lead the way in getting a more precise understanding of prostate cancer, including by using AI tools. Today's results show that our strategic investment is now delivering exactly what we were aiming for: tools that identify men most likely to benefit from a treatment.
"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 a way to make this an even more cost-effective approach. We therefore echo the researchers' urgent call for abiraterone to be made available to those men whose lives it can save - men who, thanks to this research, we can now identify more precisely than ever before."
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 spent £20,000 on his treatment so far. He said: "This is great research and adds even more reason for NHS England to start funding this treatment now. I find it very difficult to come to terms with having to pay for this treatment, whereas if I was with the NHS in Scotland or Wales I would not. Even more important are the thousands of men in England who are missing out on this cheap, life-saving and cost-saving drug. Action must be taken by NHS England and the government right now."
The trial results were presented at the American Society of Clinical Oncology (ASCO) Annual Meeting 2025. 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 is funded by Cancer Research UK.
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