The ArteraAI Prostate Test: What It Is and How It Works

The economic advantage of the ArteraAI-guided strategy in the cost-effectiveness analysis depends entirely on the test's ability to accurately identify patients who will not benefit from ADT.

In this segment, Amar U. Kishan, MD, of UCLA explains how the ArteraAI Prostate Test was constructed to accurately identify patients who will not benefit from ADT. The test integrates standard clinical inputs such as baseline PSA, Gleason score, primary and secondary Gleason pattern, and clinical T stage with computational features derived from digitized histopathology slides of the biopsy specimen. The resulting continuous score is used to classify patients as ArteraAI-positive or ArteraAI-negative. A positive result indicates a patient predicted to derive meaningful benefit from short-course ADT; a negative result indicates one who is not.

The test was trained on data from 2 cooperative group trials, RTOG 9910 and RTOG 0126, and subsequently validated on NRG/RTOG 9408—a large randomized trial in which men with intermediate-risk prostate cancer received radiotherapy alone or radiotherapy plus 4 months of ADT.

The RTOG 9408 validation results showed that among ArteraAI-positive patients, the 15-year distant metastasis rate was 14.4% with radiation alone vs 4.0% with combination therapy (hazard ratio, 0.34). Among ArteraAI-negative patients, rates were 7.4% and 6.9%, respectively (HR, 0.92). Critically, more than 60% of patients in the trial cohort were biomarker-negative. Kishan underscores that this majority-negative finding is not a limitation of the test—it is its central clinical and economic implication. A strategy that can reliably identify the majority of patients as unlikely to benefit from ADT creates a substantial opportunity to reduce unnecessary treatment.