The first artificial intelligence (AI)-powered platform to aid in the creation of personalized prostate cancer care plans, iQuest, was approved by the US Food and Drug Administration (FDA) in December 2022. Developed by Avenda Health, iQuest creates a detailed map of where cancer is located within the prostate using deep-learning algorithms and diagnostic information. Magnetic resonance imaging (MRI) focuses on the full organ and can result in almost 50% of patients losing their sexual or urinary function. iQuest helps develop treatment plans that target individual cancer sites instead of the entire prostate.
GU Oncology Now spoke with Shyam Natarajan, PhD, co-founder and CEO of Avenda Health, to discuss iQuest and how AI can be used in the field of cancer care.
Can you provide an overview of the iQuest platform and speak to how it differs from traditional methods like MRI?
Dr. Natarajan: iQuest is an AI-enabled decision support tool for urologists, primarily. It helps them make decisions once a patient is diagnosed with prostate cancer. Basically, it helps them identify what to do next in terms of knowing where cancer is extending within the gland. So, MRI and biopsy and other sorts of diagnostic tools only give you an indication of the hot spot or focus of prostate cancer. They don’t really do a good job of showing you the extent of disease.
iQuest takes in this existing information—the MRI, the biopsy, the prostate-specific antigen pathology—and puts it together into a machine-learning algorithm that has been trained on hundreds of thousands of data points and has been validated in many large studies to actually show the extent of disease.
iQuest gives doctors 2 key outputs. It gives them a cancer estimation map that shows the probability or likelihood on a pixel-by-pixel level that there’s clinically significant prostate cancer, and it also gives them an optimal contour or margin for the disease or for the lesion. This is helpful information to have if the doctors want to perform a focal treatment or if they want to use radiation therapy and target a specific foci. In essence, iQuest is giving them information about where cancer is currently in the prostate.
When did Avenda first begin progress on iQuest?
Dr. Natarajan: It’s been in development since 2014, so almost 10 years. We have been working on iQuest for quite some time, really starting with our work at UCLA when I was a professor of urology and bioengineering. One of my PhD students, Dr. Alan Priester, this was part of his thesis work that ended up getting developed over the years. And then, after Avenda Health was formed, we worked together with the university to actually validate and test iQuest in a large set of studies.
Did any improvements or shifts in AI technology occur during the production of iQuest that affected its development?
Dr. Natarajan: AI is a very rapidly changing field, and from the initial concept of iQuest to where it is today, there have been a lot of new algorithms and a better understanding of what the trade-offs, drawbacks, and benefits of certain algorithm approaches are. That was very helpful in narrowing down the final algorithm that was used to build iQuest. One of the biggest benefits in the last, I would say, 5 years, is that the medical community is becoming a lot savvier. The FDA especially has become a lot savvier in terms of how to evaluate AI technologies, how to assess for bias, for generalizability, for taking something that was developed or trained on one patient population and measuring and knowing what the benchmark is for a much more broader patient population. That is important, because we could have created the best technology in the world, but if there’s no framework from a regulatory standpoint to assess it, then it can’t get to the market.
Where do you see the progression of AI technology for genitourinary cancers heading in the next 10 years?
Dr. Natarajan: AI is going to continue to explode in terms of utilization, in terms of new products coming to the fold. I think the biggest shift or change is that physicians have started to interact and have started to become savvy about this, but I think the pace of innovation is going to continue to accelerate. And so, it’s incumbent on physicians, and I think there are going to be a lot more workshops, seminars, a lot more interest and literacy in terms of how to evaluate and use AI technologies, because you’ve seen that shift in radiology over the last 10 years, and it’s starting to happen in urology now as well.
Is there a possibility that Avenda could extend their area of focus to other genitourinary malignancies in the future?
Dr. Natarajan: Yes. Today, we’re pretty focused in the near term on the prostate cancer space, starting with therapy and then eventually going upstream in the care pathway to diagnosis, staging, and so on. But our approach can be applied—and there is interest from clinicians to apply it—to other solid organ tumors in the urology space, such as bladder cancer and kidney cancer.
