Mount Sinai urology chair Dr. Ash Tewari joins'Fox News Live' to discuss the PSA test designed to catch the'silent killer.' A new means of prostate cancer screening could emerge as an alternative to the PSA test, which has long been the first-line option. Using machine learning, a form of artificial intelligence, Swedish researchers analyzed urine samples from more than 2,000 men with prostate cancer, along with a control group. They determined that the simple, non-invasive urine test was able to detect biomarkers of prostate cancer with a high degree of accuracy -- and could also determine the grade (stage) of the disease. The results were published in the journal Cancer Research.

While deep learning methods have shown great promise in improving the effectiveness of prostate cancer (PCa) diagnosis by detecting suspicious lesions from trans-rectal ultrasound (TRUS), they must overcome multiple simultaneous challenges. There is high heterogeneity in tissue appearance, significant class imbalance in favor of benign examples, and scarcity in the number and quality of ground truth annotations available to train models. Failure to address even a single one of these problems can result in unacceptable clinical outcomes.We propose TRUSWorthy, a carefully designed, tuned, and integrated system for reliable PCa detection. Our pipeline integrates self-supervised learning, multiple-instance learning aggregation using transformers, random-undersampled boosting and ensembling: these address label scarcity, weak labels, class imbalance, and overconfidence, respectively. We train and rigorously evaluate our method using a large, multi-center dataset of micro-ultrasound data. Our method outperforms previous state-of-the-art deep learning methods in terms of accuracy and uncertainty calibration, with AUROC and balanced accuracy scores of 79.9% and 71.5%, respectively. On the top 20% of predictions with the highest confidence, we can achieve a balanced accuracy of up to 91%. The success of TRUSWorthy demonstrates the potential of integrated deep learning solutions to meet clinical needs in a highly challenging deployment setting, and is a significant step towards creating a trustworthy system for computer-assisted PCa diagnosis.

Urinary tract infections (UTIs) are a significant health concern, particularly for people living with dementia (PLWD), as they can lead to severe complications if not detected and treated early. This study builds on previous work that utilised machine learning (ML) to detect UTIs in PLWD by analysing in-home activity and physiological data collected through low-cost, passive sensors. The current research focuses on improving the performance of previous models, particularly by refining the Multilayer Perceptron (MLP), to better handle variations in home environments and improve sex fairness in predictions by making use of concepts from multitask learning. This study implemented three primary model designs: feature clustering, loss-dependent clustering, and participant ID embedding which were compared against a baseline MLP model. The results demonstrated that the loss-dependent MLP achieved the most significant improvements, increasing validation precision from 48.92% to 72.60% and sensitivity from 27.44% to 70.52%, while also enhancing model fairness across sexes. These findings suggest that the refined models offer a more reliable and equitable approach to early UTI detection in PLWD, addressing participant-specific data variations and enabling clinicians to detect and screen for UTI risks more effectively, thereby facilitating earlier and more accurate treatment decisions.

Prostate cancer is a major cause of cancer-related deaths in men, where early detection greatly improves survival rates. Although MRI-TRUS fusion biopsy offers superior accuracy by combining MRI's detailed visualization with TRUS's real-time guidance, it is a complex and time-intensive procedure that relies heavily on manual annotations, leading to potential errors. To address these challenges, we propose a fully automatic MRI-TRUS fusion-based segmentation method that identifies prostate tumors directly in TRUS images without requiring manual annotations. Unlike traditional multimodal fusion approaches that rely on naive data concatenation, our method integrates a registration-segmentation framework to align and leverage spatial information between MRI and TRUS modalities. This alignment enhances segmentation accuracy and reduces reliance on manual effort. Our approach was validated on a dataset of 1,747 patients from Stanford Hospital, achieving an average Dice coefficient of 0.212, outperforming TRUS-only (0.117) and naive MRI-TRUS fusion (0.132) methods, with significant improvements (p $<$ 0.01). This framework demonstrates the potential for reducing the complexity of prostate cancer diagnosis and provides a flexible architecture applicable to other multimodal medical imaging tasks.

Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, which demonstrates the ability of LLMs to handle tasks needed for tumor documentation. Open source LLMs show a strong potential for automating tumor documentation. Models from 7-12 billion parameters could offer an optimal balance between performance and resource efficiency. With tailored fine-tuning and well-designed prompting, these models might become important tools for clinical documentation in the future. The code for the evaluation is available from https://github.com/stefan-m-lenz/UroLlmEval. We also release the dataset as a new valuable resource that addresses the shortage of authentic and easily accessible benchmarks in German-language medical NLP.

Histopathological image analysis is a reliable method for prostate cancer identification. In this paper, we present a comparative analysis of two approaches for segmenting glandular structures in prostate images to automate Gleason grading. The first approach utilizes a hand-crafted learning technique, combining Gray Level Co-Occurrence Matrix (GLCM) and Local Binary Pattern (LBP) texture descriptors to highlight spatial dependencies and minimize information loss at the pixel level. For machine driven feature extraction, we employ a U-Net convolutional neural network to perform semantic segmentation of prostate gland stroma tissue. Support vector machine-based learning of hand-crafted features achieves impressive classification accuracies of 99.0% and 95.1% for GLCM and LBP, respectively, while the U-Net-based machine-driven features attain 94% accuracy. Furthermore, a comparative analysis demonstrates superior segmentation quality for histopathological grades 1, 2, 3, and 4 using the U-Net approach, as assessed by Jaccard and Dice metrics. This work underscores the utility of machine-driven features in clinical applications that rely on automated pixel-level segmentation in prostate tissue images.

The use of machine learning and AI on electronic health records (EHRs) holds substantial potential for clinical insight. However, this approach faces challenges due to data heterogeneity, sparsity, temporal misalignment, and limited labeled outcomes. In this context, we leverage a linked EHR dataset of approximately one million de-identified individuals from Bristol, North Somerset, and South Gloucestershire, UK, to characterize urinary tract infections (UTIs). We implemented a data pre-processing and curation pipeline that transforms the raw EHR data into a structured format suitable for developing predictive models focused on data fairness, accountability and transparency. Given the limited availability and biases of ground truth UTI outcomes, we introduce a UTI risk estimation framework informed by clinical expertise to estimate UTI risk across individual patient timelines. Pairwise XGBoost models are trained using this framework to differentiate UTI risk categories with explainable AI techniques applied to identify key predictors and support interpretability. Our findings reveal differences in clinical and demographic predictors across risk groups. While this study highlights the potential of AI-driven insights to support UTI clinical decision-making, further investigation of patient sub-strata and extensive validation are needed to ensure robustness and applicability in clinical practice.

Rare diseases, despite their low individual incidence, collectively impact around 300 million people worldwide due to the huge number of diseases. The complexity of symptoms and the shortage of specialized doctors with relevant experience make diagnosing and treating rare diseases more challenging than common diseases. Recently, agents powered by large language models (LLMs) have demonstrated notable improvements across various domains. In the medical field, some agent methods have outperformed direct prompts in question-answering tasks from medical exams. However, current agent frameworks lack adaptation for real-world clinical scenarios, especially those involving the intricate demands of rare diseases. To address these challenges, we present RareAgents, the first multi-disciplinary team of LLM-based agents tailored to the complex clinical context of rare diseases. RareAgents integrates advanced planning capabilities, memory mechanisms, and medical tools utilization, leveraging Llama-3.1-8B/70B as the base model. Experimental results show that RareAgents surpasses state-of-the-art domain-specific models, GPT-4o, and existing agent frameworks in both differential diagnosis and medication recommendation for rare diseases. Furthermore, we contribute a novel dataset, MIMIC-IV-Ext-Rare, derived from MIMIC-IV, to support further advancements in this field.

Prostate cancer is a leading cause of cancer-related deaths among men. The recent development of high frequency, micro-ultrasound imaging offers improved resolution compared to conventional ultrasound and potentially a better ability to differentiate clinically significant cancer from normal tissue. However, the features of prostate cancer remain subtle, with ambiguous borders with normal tissue and large variations in appearance, making it challenging for both machine learning and humans to localize it on micro-ultrasound images. We propose a novel Mask Enhanced Deeply-supervised Micro-US network, termed MedMusNet, to automatically and more accurately segment prostate cancer to be used as potential targets for biopsy procedures. MedMusNet leverages predicted masks of prostate cancer to enforce the learned features layer-wisely within the network, reducing the influence of noise and improving overall consistency across frames. MedMusNet successfully detected 76% of clinically significant cancer with a Dice Similarity Coefficient of 0.365, significantly outperforming the baseline Swin-M2F in specificity and accuracy (Wilcoxon test, Bonferroni correction, p-value<0.05). While the lesion-level and patient-level analyses showed improved performance compared to human experts and different baseline, the improvements did not reach statistical significance, likely on account of the small cohort. We have presented a novel approach to automatically detect and segment clinically significant prostate cancer on B-mode micro-ultrasound images. Our MedMusNet model outperformed other models, surpassing even human experts. These preliminary results suggest the potential for aiding urologists in prostate cancer diagnosis via biopsy and treatment decision-making.

The field of computational pathology has been transformed with recent advances in foundation models that encode histopathology region-of-interests (ROIs) into versatile and transferable feature representations via self-supervised learning (SSL). However, translating these advancements to address complex clinical challenges at the patient and slide level remains constrained by limited clinical data in disease-specific cohorts, especially for rare clinical conditions. We propose TITAN, a multimodal whole slide foundation model pretrained using 335,645 WSIs via visual self-supervised learning and vision-language alignment with corresponding pathology reports and 423,122 synthetic captions generated from a multimodal generative AI copilot for pathology. Without any finetuning or requiring clinical labels, TITAN can extract general-purpose slide representations and generate pathology reports that generalize to resource-limited clinical scenarios such as rare disease retrieval and cancer prognosis. We evaluate TITAN on diverse clinical tasks and find that TITAN outperforms both ROI and slide foundation models across machine learning settings such as linear probing, few-shot and zero-shot classification, rare cancer retrieval and cross-modal retrieval, and pathology report generation.