Abiraterone can half some men’s risk of dying – this AI test can work out who

The hormone therapy abiraterone has already extended the lives of hundreds of thousands of men with advanced prostate cancer. 

Now, researchers have developed an AI tool that can pick out which men could benefit even before their high-risk cancer spreads further. 

As a result, we’re renewing our push on the Government to make this life-extending treatment available to these men on the NHS in England and Northern Ireland – two years after Scotland and Wales did the same.

Result adds pressure on NHS to fund abiraterone for more men

For around a quarter of men whose prostate cancer has not yet spread but is at high risk of doing so, abiraterone can half their risk of dying from the disease. 

But, until now, we didn’t have a reliable way to pick out those men – making it hard for the NHS to approve it and leading to a postcode lottery of availability in the UK. 

Thanks to research you helped to fund, however, an international team has built an AI test that can pick out which of these men with high-risk cancer would benefit most from the game-changing hormone therapy, and which men would do better on standard treatment (radiotherapy and other hormone therapy). 

This approach, moving away from a 'one size fits all' model, to giving men the treatment that works best for them according to their biology, is known as precision medicine.

The finding also means offering abiraterone to this group of men would be cheaper than previously thought – adding pressure on NHS England to review its decision not to fund the treatment. 

AI test spots patterns in who benefits most

Abiraterone works by suppressing the production of the hormone testosterone throughout the body, making it harder for prostate cancer cells to grow, even if they have spread beyond the prostate.  

Since its approval, abiraterone has helped to extend the lives of hundreds of thousands of men with advanced prostate cancer worldwide. 

In 2022, the STAMPEDE clinical trial showed that some men can also benefit at an earlier stage – and, subsequently, the NHS in Scotland and Wales made the treatment available to men with high-risk prostate cancer that has not yet spread. 

This new research used an AI tool, developed by Artera Inc., to study tumour samples from more than 1,000 men who took part in STAMPEDE, picking out features that are invisible to the human eye. 

Based on this, the test assigned men to one of two groups, which researchers compared to the men’s outcomes on the trial. 

For one group of men, abiraterone cut the risk of death after five years from 17 per cent to 9 per cent, suggesting that such men would benefit greatly from taking the treatment. 

For the others, their risk fell from 7 per cent to 4 per cent – a decline that wasn’t big enough that the researchers could say with confidence that it was due to abiraterone.  

Instead, the researchers say these men would benefit more from remaining on radiotherapy and other hormone therapy – so avoiding the side effects that come from abiraterone. 

Abiraterone access is a postcode lottery

Professor Nick James, based at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, is Chief Investigator of STAMPEDE and co-led this research.  

He 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.   

“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 not to fund abiraterone for high-risk prostate cancer that has not spread.” 

Make abiraterone available to men whose lives it can save

Dr Matthew Hobbs, our Director of Research, 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, we, 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 lifesaving, 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.” 

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