Evidence mapPaperPMID 41350971Full record

ArticleMolecular imaging and biology2026

Staging Prostate Cancer with AI: A Comparative Study of Large Language Models and Expert Interpretation on PSMA PET-CT Reports.

Rashad Ismayilov, Ayse Aktas, Esra Arzu Gencoglu, Arzu Oguz, Ozden Altundag, Zafer Akcali

Abstract readComparative Study
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Article in Molecular imaging and biology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2 citing papers in PubMed.

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5 · Who and what money

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6 authors.

Rashad IsmayilovDepartment of Medical Oncology, Baskent University, Faculty of Medicine, Ankara, Türkiye. ismayilov_r@hotmail.com.ORCID http://orcid.org/0000-0002-7093-2722
Ayse AktasDepartment of Nuclear Medicine, Baskent University, Faculty of Medicine, Ankara, Türkiye.ORCID http://orcid.org/0000-0003-0149-2265
Esra Arzu GencogluDepartment of Nuclear Medicine, Baskent University, Faculty of Medicine, Ankara, Türkiye.ORCID http://orcid.org/0000-0003-4631-1683
Arzu OguzDepartment of Medical Oncology, Baskent University, Faculty of Medicine, Ankara, Türkiye.ORCID http://orcid.org/0000-0001-6512-6534
Ozden AltundagDepartment of Medical Oncology, Baskent University, Faculty of Medicine, Ankara, Türkiye.ORCID http://orcid.org/0000-0003-0197-6622
Zafer AkcaliDepartment of Medical Oncology, Baskent University, Faculty of Medicine, Ankara, Türkiye.ORCID http://orcid.org/0000-0003-2473-4431

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAccurate staging of prostate cancer is essential for therapeutic decision-making. While PSMA PET-CT reports offer rich clinical data, their unstructured format hinders large-scale analysis. Recent advances in large language models (LLMs) offer new opportunities to extract structured information from narrative radiology reports. However, their ability to perform multi-step clinical reasoning, particularly for cancer staging, remains underexplored.

methodsIn this feasibility study, 80 anonymized, Turkish-language PSMA PET-CT reports were independently interpreted by two LLMs-Gemini 2.5 Pro (Google) and ChatGPT 4o (OpenAI). Using a structured prompt containing an embedded knowledge base (AJCC/CHAARTED criteria) and few-shot examples, both LLMs generated classifications for T, N, M, and overall clinical stage/disease volume. Outputs were benchmarked against expert classifications by a senior nuclear medicine specialist. Performance was evaluated using accuracy, precision, recall, F1-score, and Cohen's kappa.

resultsFor the composite task of classifying clinical stage and disease volume, Gemini 2.5 Pro achieved an accuracy of 93.8% (95% CI: 86.0-97.9) and a Cohen's kappa of 0.910 (95% CI: 0.834-0.986), while ChatGPT 4o achieved 91.3% accuracy (95% CI: 82.8-96.4) with a kappa of 0.874 (95% CI: 0.786-0.962). For T staging, Gemini showed a higher accuracy point estimate (95.0% [95% CI: 87.7-98.6] vs. 91.3% [95% CI: 82.8-96.4]), while both models excelled at the binary N and M classifications, achieving accuracies above 95% and kappa values indicating near-perfect agreement (κ > 0.900).

conclusionsLLMs, when guided by expert-informed prompt engineering, can accurately stage prostate cancer from free-text PSMA PET-CT reports and may serve as a powerful assistive tool for data automation, research acceleration, and quality assurance.

Indexed as

Antigens, SurfaceArtificial IntelligenceGlutamate Carboxypeptidase IILanguagePositron Emission Tomography Computed TomographyProstatic NeoplasmsAgedHumansLarge Language ModelsMaleNeoplasm StagingAntigens, SurfaceFOLH1 protein, humanGlutamate Carboxypeptidase IIArtificial intelligenceCancer stagingClassificationLarge language modelsNatural language processingProstate cancerPSMA PET-CT

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