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Expert insights for January – Professor Nikhil Vasdev
What do you think are the 3 most significant practice breakthroughs in prostate cancer diagnosis and treatment in 2025?
The first is the increasing application of pre and intraoperative AI in Surgical Planning during Nerves sparing Robotic Prostatectomy
In 2024, the expansions in the surgical treatment of prostate cancer continue to evolve. With the increasing advent of AI into clinical practice both in the pre-operative planning with MRI and digitalisation of pathology, surgery now is seeing an increasing adoption [1].
AI has an increasing role to play an important role in enhanced nerve sparing Robotic Prostatectomy to enhance surgical analysis and improve functional outcomes [2]. New AI Algorithms can help surgeons in numerous aspects in surgical planning preoperatively and intraoperatively. The technique of NEUROSAFE Robotic prostatectomy allows real time analysis of nerve bundle tissue during surgery allowing improvement in nerve sparing resulting in both improved postoperative sexual and functional outcomes without any oncological compromise [3]. Recent studies have shown that AI-enhanced Robotic Surgical Systems reduce operative times whilst improving patient outcomes [4].
The advent of newer AI systems allows the deployment of neural networks to predict outcomes such as intraoperative bleeding during Robotic Prostatectomy with a sensitivity of up to 98% [4]. The use of AI in postoperative rehabilitation allows the possibility of preventing post-operative complications using fitness tracker data following major urological surgery. This new unique approach using AI and Robotic Surgery will see patient safety improve further.
We are currently working on the PAIR – 2 Trial with Lucida Medical. This unique trial is evaluating the use of pre-operative MRI, Pi from Lucida and our Enhanced Robotic Prostatectomy programme. I presented this data at Mount Sinai Hospital, New York in December 2024 which was very well received. The unique aspect of this data allows a strong correlation with intraoperative histology during nerve sparing robotic prostatectomy and the pre-operative MRI to allow accurate nerve spare planning. With plans to launch a multicentre PAIR-2 Trial, this will also potentially free the time of pathologist who can spend up to 2 hours during each Robotic prostatectomy analysing the margin status live during surgery.
The second is the integration of artificial intelligence (AI) in the diagnostic pathway of prostate cancer. Its adoption has significantly improved the interpretation of imaging data and patient stratification. Advanced AI algorithms can assist radiologists in evaluating MRI scans and other imaging modalities, increasing accuracy and efficiency in diagnosing and categorising patients, including those suitable for active surveillance (AS). This integration reduces human error and enhances personalised treatment planning.
There is also a constant increased uptake of MRI and PSMA-PET, which have become a cornerstone in prostate cancer diagnostics. This dual-modality approach offers unparalleled sensitivity and specificity, allowing for more precise localisation and staging of prostate cancer.
The third is the role of liquid biomarkers. The utilisation of liquid biomarkers, including circulating tumour cells (CTCs) and cell-free DNA, has revolutionised non-invasive diagnostics. These biomarkers enable early detection, monitoring of disease progression, and response to treatment, providing a less invasive alternative to traditional tissue biopsies.

More about Professor Nikhil Vasdev
Expert insights for November – Associate Professor Francesco Giganti
What do you think are the 3 most significant practice breakthroughs in prostate cancer diagnosis in 2024?
The first is the integration of artificial intelligence (AI) in the diagnostic pathway of prostate cancer. Its adoption has significantly improved the interpretation of imaging data and patient stratification. Advanced AI algorithms can assist radiologists in evaluating MRI scans and other imaging modalities, increasing accuracy and efficiency in diagnosing and categorising patients, including those suitable for active surveillance (AS). This integration reduces human error and enhances personalised treatment planning.
The second the constant increased uptake of MRI and PSMA-PET, which have become a cornerstone in prostate cancer diagnostics. This dual-modality approach offers unparalleled sensitivity and specificity, allowing for more precise localisation and staging of prostate cancer.
The third is the roe of liquid biomarkers. The utilisation of liquid biomarkers, including circulating tumour cells (CTCs) and cell-free DNA, has revolutionised non-invasive diagnostics. These biomarkers enable early detection, monitoring of disease progression, and response to treatment, providing a less invasive alternative to traditional tissue biopsies.
What have been the most important publications in prostate cancer diagnosis in the first half of 2024?
The first is the PI-CAI study published in The Lancet Oncology. It highlights the efficacy of AI in enhancing the accuracy of prostate cancer diagnostics. An AI system was superior to radiologists, on average, at detecting clinically significant prostate cancer and comparable to the standard of care. However, prospective validation is needed to test clinical applicability of this system.
The second is the updated version of the Prostate Imaging Quality score (PI-QUAL v2), published in European Radiology. The new standardised scoring system for MRI quality, can be used both for multiparametric MRI and MRI without intravenous injection of contrast medium (i.e., biparametric MRI) and will help global consistency in the acquisition of images of adequate diagnostic quality.
The third is the PROBASE trial published in European Urology. It has shown that prostate MRI accuracy is moderate for men aged 45 years but can be increased by a second reading of the images by expert radiologists. Therefore, for broad application of MRI in routine screening, double reading should be advisable.
In 3-4 months – What do you think will be the next 2-3 big changes in prostate cancer diagnosis, when and why?
The first is the development of novel biomarkers and liquid biopsy technologies, which is expected to enhance early detection and reduce the need for invasive procedures.
The second is the improvement of Imaging Quality Standards using dedicated standardised scoring systems like PI-QUAL v2. Initiatives aiming at improving image quality globally to facilitate better diagnosis and management decisions are already under way (e.g. American College of Radiology).

More about Dr Francesco Giganti
Expert insights for September – Professor Anwar Padhani
Let’s talk about prostate cancer diagnosis and what we expect to happen over the next year or so. When I started thinking about this topic, I asked myself three questions:
- What are the most recent changes in the way we think about prostate cancer diagnosis?
- What have been the most important publications, guideline changes, and conference presentations recently?
- What will be the next big changes in the MRI diagnostic pathway, and why and how will these happen?
Let’s start by considering the main benefits of the MRI pathway compared to traditional prostate cancer diagnosis. Benefits arise from accurate results, including true negatives, which improve the negative predictive value. In the early detection setting, MRI can reduce the number of patients undergoing unnecessary biopsies and the diagnosis of indolent cancers. True positive results allow for more accurate targeted biopsies and tumour grading. MRI is not inferior in detecting clinically significant cancers in biopsy-naive men.
Early disease detection refers to identifying men with a high likelihood of having clinically significant cancers, typically those who present themselves at a urological clinic. This differs from screening, which targets a healthy population to identify individuals who may have harmful cancers. The key difference is the pretest probability or cancer prevalence.
The modern MRI pathway, as depicted in the EAU guidelines, involves risk-based assessments by urologists, followed by MRI, and subsequent evaluation for the need for biopsy. These assessments help reduce the number of men undergoing unnecessary investigations, thereby minimising harm without compromising the detection of clinically significant cancers. The benefits include timely treatment and reduced overdiagnosis and biopsy rates. Harm can result from false positives (unnecessary biopsies) and false negatives (missed cancers).
A fundamental foundation of this pathway is PIRADS compliance, ensuring the protocol is followed as prescribed. This is crucial because higher suspicion levels for clinically significant cancers increase the likelihood of finding them. Quality assurance is another foundational element, involving automation, image quality checks, certification of personnel, and accreditation of diagnostic centres.
Patient preferences also play a role. Younger patients with strong family histories or those of Black ethnicity may be more cancer-averse, prioritizing detection over concerns about biopsy complications. In contrast, older patients with comorbidities may be more concerned about biopsy risks and less about low-risk disease.
We also need to consider the balance of benefits and harms in decision-making. Decision curve analysis helps assess the net benefit of MRI by weighing cancer detection against patient preferences for biopsy, depending on pretest probability. Analysis highlights how MRI can be more effective in detecting clinically significant cancers, especially when the threshold probability is low.
Looking ahead, we expect to see more use of MRI without contrast medium, especially in cases where image quality is high and for expert readers. Recent studies have shown that biparametric MRI can be as effective as multiparametric MRI in yielding biopsy results for clinically significant cancers. However, this shift will require further confirmation from prospective randomised studies.
Additionally, we anticipate more data on reader variability from the PI-CAI challenge, focusing on deep learning and computer-aided detection. Recent findings suggest that AI can outperform radiologists using the PIRADS system, with fewer false positives and false negatives. The upcoming PARADIGM study will test the hypothesis that AI is not inferior to radiologists in diagnosing clinically significant cancers.
We are also seeing advancements in risk calculators that incorporate PIRADS scores, PSA levels, and AI to refine biopsy decisions. A recent study demonstrated that a deep learning algorithm outperformed PIRADS with PSA density, suggesting a potential future where AI might replace radiologists Nomograms.
Furthermore, we foresee a shift toward targeting only what is seen on MRI or AI analysis for biopsy and treatment, as supported by the EAU 2024 guidelines. This approach minimises the need for systematic biopsies.
In conclusion, the future involves new thinking about early detection versus screening, risk-based patient assessments, and accounting for patient preferences. The MRI pathway requires optimisation through adherence to PIRADS guidelines, quality assurance, automation, AI, and personalised protocols. Integration with clinical biomarkers and multidisciplinary collaboration will also be essential. Quality monitoring and key performance indicators will ensure the pathway’s effectiveness and safety.

More about Professor Anwar Padhani
Sectra distribution agreement via Amplifier
Lucida Medical Ltd announces a distribution agreement with Sectra to offer Pi AI technology to help diagnose prostate cancer
Lucida Medical today announced that it has signed a distribution agreement with international medical imaging IT and cybersecurity company Sectra. Through this agreement, the Lucida Pi application for diagnosing prostate cancer from MRI images will be offered through the Sectra Amplifier Marketplace. This greatly expands the availability of Pi to assist healthcare by improving the speed and accuracy of prostate cancer diagnosis.

Learn more about Sectra Amplifier
Macmillan Invest in Lucida AI
Macmillan Cancer Support is investing in Lucida Medical, a spin-off from the University of Cambridge that develops Pi™ software to help radiologists find cancer
Macmillan Cancer Support, the UK’s leading cancer charity, is investing £350,100 in Lucida Medical’s pioneering new AI platform, Pi™, with the aim of improving the speed and accuracy of prostate cancer tests. This could help to improve early detection and treatment and reduce the number of cancer-free patients going through more invasive investigative procedures, as well as potentially saving NHS time and money.

More about the MacMillan investment
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