Leveraging AI Predictive Models and Genomic Biomarkers in Prostate Cancer Management

Document Type : Policy Brief

Authors
1 Medical Physics Department, School of Medicine, School of Medicine & Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Anatomy and Reproductive Biology Department, School of Medicine& Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran..
4 Radio Oncology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
5 Anatomy and Reproductive Biology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Prostate cancer is one of the major challenges facing healthcare systems and requires the achievement of personalized medicine for men in order to properly address treatment response heterogeneity and biochemical recurrence rates. Drawing on the results of applying advanced machine learning models and deep neural networks such as DeepSurv, this policy brief explains the potential of radiogenomics in accurately predicting treatment outcomes. Evidence indicates that the simultaneous use of quantitative features extracted from MRI images and key genetic biomarkers, including Ki-67, PTEN, and the Decipher index, provides a valuable opportunity for non-invasive prediction of disease recurrence with high accuracy. Focusing on performance indicators, the findings of this study confirm that replacing or augmenting conventional diagnostic methods with interpretable AI tools can enable intelligent classification of patients into high-risk and low-risk groups before the initiation of radiotherapy. Implementing this approach at the level of macro health policy can lead to a reduction in unnecessary treatments, better management of side effects, and optimized financial resources. Moreover, by enabling adaptive and personalized radiotherapy, it can significantly improve survival rates and patients’ quality of life. In this regard, three policy strategies were proposed and analyzed: “defining radiogenomics in screening protocols,” “personalizing radiotherapy dose based on DeepSurv risk,” and “establishing a national prostate radiogenomics data network.” Ultimately, this document emphasizes the need to strengthen clinical decision-making and employ intelligent decision support systems to achieve treatment equity and efficient cancer management.
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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49 .
2. Etedali A. Hosseni A. Derakhshandeh A. Mehrzad V. Sharifi M. Azadeh Moghaddas A. Melatonin in the Management of Mood and Sleep Problems Induced by Androgen Deprivation Therapy in Prostate Cancer Patients: A Randomized Double-blinded, Placebo-controlled Clinical Trial. Iran J Pharm Res. 2022 December; 21(1):e128817. https://doi.org/10.5812/ijpr-128817
3. Xiong Y, Rabe M, Nierer L et al. Assessment of intrafractional prostate motion and its dosimetric impact in MRI-guided online adaptive radiotherapy with gating. Strahlenther Onkol 2023;199:544–53. https://doi.org/10.1007 /s00066-022-02005-1
 4.   Jameson JL, Longo DL. Precision medicine personalized, problematic, and promising. N Engl J Med. 2015;372(23):2229-34 .
5.  Ibrahim A, Primakov S, Beuque M, et al. Radiomics for precision medicine: current challenges, future prospects, and the proposal of a new framework. Methods. 2021;188:20-9 .
6.   Lo Gullo R, Daimiel I, Morris EA, Pinker K. Combining molecular and imaging metrics in cancer: Radiogenomics. Insights Imaging. 2020;11(1):1 .
7. Taheri H, Tavakoli M, Farghadani M, Lafzlenjani Sh, Taheri  H. Machine learning-DeepSurv prediction model integrating mpMRI radiomics and genomic biomarkers for BCR-free survival and tumor response in prostate radiotherapy Hossein. Journal of Radiation Research, 2025: 1–11. https://doi.org/10.1093/jrr/rraf079 8. Cao L, He R, Zhang A et al. Development of a deep learning system for predicting biochemical recurrence in prostate cancer. BMC Cancer 2025;25:232. https://doi.org/10.1186/s12885-025-13628-9.