Artificial intelligence versus multidisciplinary teams in high-risk prostate cancer with positive surgical margins: a pilot proof-of-concept study
DOI:
https://doi.org/10.48193/vfsvwx11Keywords:
Artificial intelligence, prostate cáncer, positive surgical margins, multidisciplinary teams, decision-making, radical prostatectomyAbstract
Objective: to compare treatment recommendations from multidisciplinary teams (MDTs) and artificial intelligence (AI) in high- and very high-risk prostate cancer (PCa) with positive surgical margins (PSM) after radical prostatectomy (RP).
Design, methodology or approach: we conducted a retrospective proof-of-concept study at a tertiary referral center. Among 700 men who underwent RP between 2010–2024, 76 had PSM, and 14 had documented preoperative MDT discussions. Five patients fulfilled inclusion criteria: high-/very high-risk PCa (per NCCN), confirmed PSM, and both pre- and postoperative MDT evaluations. Clinical and pathological data were entered into ChatGPT-4.0 (OpenAI), primed with NCCN, AUA, and EAU guidelines. The AI was queried in a zero-shot manner for treatment recommendations, and concordance was evaluated using Cohen’s kappa (κ).
Results: five patients were included in the final analysis. AI recommendations aligned with MDT decisions in 2 of 5 cases (40 %) both preoperatively and postoperatively. Agreement was minimal for initial therapy (κ = 0.00) and slight for postoperative management (κ = 0.12).
Limitations or implications: this pilot study is limited by its small sample size and retrospective design, restricting generalizability.
Originality or value: this is the first study to directly compare AI-driven and MDT recommendations in high-risk PCa with PSM in Mexico.
Findings or conclusions: AI generated rapid, guideline-based recommendations, but showed limited concordance with MDT decisions in this pilot cohort. AI may support efficiency and guideline adherence as an adjunctive tool; however, this study did not evaluate whether either recommendation strategy leads to superior clinical outcomes.
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