Development, multi-institutional external validation, and algorithmic audit of SEPERA – An artificial intelligence-based side-specific extra-prostatic extension risk assessment tool for patients undergoing radical prostatectomy

You have accessJournal of UrologyCME1 Apr 2023MP61-02 DEVELOPMENT, MULTI-INSTITUTIONAL EXTERNAL VALIDATION, AND ALGORITHMIC AUDIT OF SEPERA - AN ARTIFICIAL INTELLIGENCE-BASED SIDE-SPECIFIC EXTRA-PROSTATIC EXTENSION RISK ASSESSMENT TOOL FOR PATIENTS UNDERGOING RADICAL PROSTATECTOMY Jethro Kwong, Adree Khondker, Eric Meng, Nicholas Taylor, Cynthia Kuk, Nathan Perlis, Girish Kulkarni, Robert Hamilton, Neil Fleshner, Antonio Finelli, Theodorus Van Der Kwast, Amna Ali, Munir Jamal, Frank Papanikolaou, Thomas Short, John Srigley, Valentin Colinet, Alexandre Peltier, Romain Diamand, Yolene Lefebvre, Qusay Mandoorah, Rafael Sanchez-Salas, Petr Macek, Xavier Cathelineau, Martin Eklund, Alistair Johnson, Andrew Feifer, and Alexandre Zlotta Jethro KwongJethro Kwong More articles by this author , Adree KhondkerAdree Khondker More articles by this author , Eric MengEric Meng More articles by this author , Nicholas TaylorNicholas Taylor More articles by this author , Cynthia KukCynthia Kuk More articles by this author , Nathan PerlisNathan Perlis More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , Robert HamiltonRobert Hamilton More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , Theodorus Van Der KwastTheodorus Van Der Kwast More articles by this author , Amna AliAmna Ali More articles by this author , Munir JamalMunir Jamal More articles by this author , Frank PapanikolaouFrank Papanikolaou More articles by this author , Thomas ShortThomas Short More articles by this author , John SrigleyJohn Srigley More articles by this author , Valentin ColinetValentin Colinet More articles by this author , Alexandre PeltierAlexandre Peltier More articles by this author , Romain DiamandRomain Diamand More articles by this author , Yolene LefebvreYolene Lefebvre More articles by this author , Qusay MandoorahQusay Mandoorah More articles by this author , Rafael Sanchez-SalasRafael Sanchez-Salas More articles by this author , Petr MacekPetr Macek More articles by this author , Xavier CathelineauXavier Cathelineau More articles by this author , Martin EklundMartin Eklund More articles by this author , Alistair JohnsonAlistair Johnson More articles by this author , Andrew FeiferAndrew Feifer More articles by this author , and Alexandre ZlottaAlexandre Zlotta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Accurate prediction of side-specific extraprostatic extension (ssEPE) is critical for performing nerve-sparing surgery to mitigate treatment-related side effects in patients with localized prostate cancer. Artificial intelligence (AI) may provide more personalized ssEPE predictions to better inform nerve-sparing strategy during radical prostatectomy. METHODS: 4936 prostatic lobes (cases) were included. SEPERA, an AI-based Side-specific Extra-Prostatic Extension Risk Assessment tool, was trained on 1022 cases from a community network, Trillium Health Partners, Canada. SEPERA was validated on 3914 cases from three academic centers: Princess Margaret Cancer Centre, Canada; L’Institut Mutualiste Montsouris, France; and Jules Bordet Institute, Belgium. Performance was assessed by area under receiver-operating characteristic curve (AUROC), area under precision-recall curve (AUPRC), calibration, and net benefit. An algorithmic audit was conducted to assess model bias and identify common characteristics among predictive errors. SEPERA was compared against contemporary nomograms, as well as a separate logistic regression model using the same variables from SEPERA. RESULTS: SEPERA was well calibrated and had the best performance across all validation cohorts (Table 1), enabling more patients to safely undergo nerve-sparing. No significant difference in AUROC was observed when stratified by race, biopsy year, age, biopsy type (systematic only vs systematic and MRI-targeted), biopsy location (academic vs community), and D’Amico risk group. In patients with pathological ssEPE despite benign ipsilateral biopsies, SEPERA correctly predicted ssEPE in 68% of cases, compared to 0-44% for other models. The most common errors were false positives, particularly for older patients with higher risk disease. No aggressive tumours (i.e., > Grade Group 2 or high-risk disease) were found among false negatives. CONCLUSIONS: We show the accuracy, safety, and generalizability of SEPERA – a novel AI-based assessment tool to personalize nerve-sparing approaches during radical prostatectomy. SEPERA is available at https://sepera.streamlitapp.com/. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e852 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jethro Kwong More articles by this author Adree Khondker More articles by this author Eric Meng More articles by this author Nicholas Taylor More articles by this author Cynthia Kuk More articles by this author Nathan Perlis More articles by this author Girish Kulkarni More articles by this author Robert Hamilton More articles by this author Neil Fleshner More articles by this author Antonio Finelli More articles by this author Theodorus Van Der Kwast More articles by this author Amna Ali More articles by this author Munir Jamal More articles by this author Frank Papanikolaou More articles by this author Thomas Short More articles by this author John Srigley More articles by this author Valentin Colinet More articles by this author Alexandre Peltier More articles by this author Romain Diamand More articles by this author Yolene Lefebvre More articles by this author Qusay Mandoorah More articles by this author Rafael Sanchez-Salas More articles by this author Petr Macek More articles by this author Xavier Cathelineau More articles by this author Martin Eklund More articles by this author Alistair Johnson More articles by this author Andrew Feifer More articles by this author Alexandre Zlotta More articles by this author Expand All Advertisement PDF downloadLoading ...