Hybrid AI framework for automated prostate cancer disease state ascertainment from real-world electronic health records.

Abstract

e17003 Background: Accurate ascertainment of prostate cancer (PCa) disease states—biochemical recurrence (BCR), castration-sensitive prostate cancer (CSPC), and castration-resistant prostate cancer (CRPC)—is critical for automated clinical trial enrollment, quality improvement initiatives, and real-world evidence generation. Essential information for disease state ascertainment resides in unstructured EHR data, requiring labor-intensive manual abstraction that is inconsistent and not scalable. We developed an automated hybrid AI framework using large language models to identify PCa disease states from real-world EHR data. Methods: This retrospective study included patients with histopathologically confirmed PCa (2017-2022) and ≥3 years follow-up. Sequential EHR data—including PSA and testosterone levels, clinical notes, pathology and radiology reports—were retrieved across temporal points. BCR was identified using rule-based algorithms (post-radical prostatectomy [RP]: PSA ≥0.2 ng/mL ×2; post-radiation therapy [RT]: nadir + 2 ng/mL ×2). CRPC was determined using androgen deprivation therapy (ADT) timing, PSA kinetics, testosterone < 50 ng/dL, and radiographic progression per PCWG/EAU-ASCO criteria. GPT-4o with structured parametrized prompts extracted metastatic status and radiographic progression. Independent clinicians performed manual annotation for validation. The framework was developed on 10% of data with evaluation on 90%. External validation used a held-out cohort of clinical trial patients. Results: Among 200 PCa patients (median age 66 years [IQR 60-71]; 91% White, 93% non-Hispanic), the framework demonstrated high accuracy: PCa diagnosis (92%), RP dates (94%), RT dates (93%), and ADT initiation (92%). For disease state identification, BCR detection achieved 90% accuracy, castration status 93%, and metastatic state (M0/M1) 87%. External validation on trial-enrolled patients confirmed robust performance: 26/31 (84%) CRPC trial patients and 26/27 (96%) CSPC trial patients were correctly classified, validating the framework’s reliability for clinical trial matching. Conclusions: This hybrid LLM-based framework accurately identifies PCa disease states using real-world EHR data with minimal manual intervention. The system offers a scalable, reproducible approach for automated disease state identification, enabling streamlined clinical trial matching and enhanced real-world data curation in oncology.