Can a digital-pathology AI tell us which very high-risk prostate cancer patients actually need abiraterone on top of ADT and radiotherapy? We've previously seen that adding abiraterone to ADT and RT improved survival in STAMPEDE's clinically very high-risk localized disease. This post-hoc analysis applied a locked multimodal AI model (ArteraAI) to 1137 patients across two sequential STAMPEDE abiraterone trials. The upper score quartile was defined as MMAI very high-risk (n=268), and the rest were considered standard high-risk (n=869). The payoff: the MMAI very high-risk group saw a large metastasis free survival benefit from abiraterone at 5 years (62%→81%), while the standard high-risk group saw little improvement (82%→84%). Tellingly, image features drove 77% of the predictiveness, and clinical factors alone showed no such interaction. | Parker, Ann Oncol 2026
