Last year, more than 800 prostate MRI scans were done at The York/WellSpan, and Dr. Steiner read about 700 of those scans. That number is expected to increase due to the change in guidelines for PCa diagnosis published by the American College of Radiology (ACR).

Last year, 400 of those cases were biopsied.

Dr. Steiner’s challenges: the biology of PCa

Among biopsy pathology results, research shows that complete agreement was seen in 56% of cases. Dr. Steiner finds this fact quite concerning as, in general, the field is more likely to undergrade a pathology of prostate cancer.

The undergrading of prostate tumors comes primarily from the fact that these tumors are mainly heterogeneous and multi-focal, which makes prostate MRI interpretation more complex and a challenge to master. Even though Dr. Steiner recognizes that PI-RADS is a great grading system, he thinks radiologists could benefit from some support. That’s why he was excited about the potential of an AI solution applied to prostate imaging.

“I believe in AI and the support that it brings to prostate MRI interpretation and to the PCa workflow as a whole.” says Dr. Steiner.

Most valuable features of Saige Prostate (formerly Quantib® Prostate) for Dr. Steiner

In his experience, Dr. Steiner found that the AI of our software is very valuable, especially because it returns results, such as the prostate volume and the PSA density, within seconds of inputting the PSA value.

In addition, the software analyzes the kinetic curves of enhancement, an important feature to Dr. Steiner as they help him assess tumor heterogeneity and rapid inflow and outflow patterns, making him even more alert for cancerous tissue.

Furthermore, Dr. Steiner also finds the bi-parametric combination image that is provided by the software quite useful since it highlights suspicious areas. Dr. Steiner indicated that this makes it truly easy to focus on the areas that require his further attention.

Lastly, Dr. Steiner values the standardized report that the software automatically generates. It is a structured, complete description that referring physicians like to see.

WellSpan completed a validation study of Saige Prostate

To further test the performance and the utility of Saige Prostate, Dr. Steiner and his team looked at 25 sequential cases of clinically significant prostate cancer retrospectively. Those cases were initially read by three board-certified radiologists and underwent fusion biopsy afterwards.

During RSNA 2022, Dr. Steiner announced that Saige Prostate detected all lesions, demonstrating a sensitivity rate of 100%, and detected 0 false negative and four false positive readings, achieving a positive predictive value (PPV) of approximately 90%. He also stated that nine of the detected lesions by Saige Prostate were previously under-called by radiologists. As Dr. Steiner expressed during his presentation, those were later confirmed as cancer by biopsies.

Saige Prostate showed a clinical impact at WellSpan

Dr. Steiner found that Saige Prostate can make prostate MRI interpretation significantly more rapid and accurate. He believes it could easily reduce interpretation time by 30% or even more once radiologists get more comfortable with the technology.

Saige Prostate also helps him focus on secondary abnormalities that may not be immediately obvious. There have been multiple cases where the AI software highlighted a second, less prominent ROI that he overlooked in his first read, and after the biopsy, he found that those were indeed cancer. A surprising added value, according to Dr. Steiner.

He also believes the tool could be exceedingly valuable for teaching prostate MRI interpretation. He has noticed that the starting radiologists he trains can initially be slightly uncomfortable when reading prostate MRI, so it is of tremendous help for them to support their training.

“Saige Prostate is much more helpful than I would have ever imagined given all the buzz about AI. But this buzz is real, this is truly a nice product,” said Dr. Steiner.

• Specialist in diagnostic radiology
• Current Chief and Medical Director of The York/WellSpan Advanced Prostate Care Center
• Reads about 700 prostate MRIs every year