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For millions of American men, prostate cancer represents one of the most significant health risks of their lifetime. Within the U.S. Department of Veterans Affairs (VA), the stakes are even higher.
Approximately 90 percent of the VA’s 9.1 million enrolled Veterans are men, making prostate cancer one of the most significant health risks across the system.
Based on the U.S. lifetime risk of roughly 1 in 8 men, more than 1 million male Veterans enrolled in VA care could face prostate cancer during their lifetime. At that scale, even small improvements in screening, diagnosis and treatment can affect tens of thousands of lives.
Yet today, gaps remain — in diagnostic accuracy, workflow efficiency and patient education. A new, integrated approach that connects imaging, biopsy guidance, digital pathology and artificial intelligence (AI) is poised to change that.
Prostate cancer is highly treatable when caught early. But diagnosis is not always straightforward.
Despite advances in screening, prostate cancer diagnosis remains complex. Traditional biopsy and grading approaches can miss clinically significant disease or underestimate aggressiveness, leading to both overtreatment and delayed intervention.
Emerging evidence from AI-assisted digital pathology highlights this opportunity for improvement. In validation studies of FDA-cleared tools, additional cancers have been identified on second review in approximately 10–15% of cases that were initially interpreted as negative¹. These findings underscore the potential for AI to serve as a diagnostic safety net – supporting pathologists in reducing missed disease and increasing confidence in clinical decision-making.
“We have an opportunity to dramatically improve accuracy [of diagnosis],” said Kevin Coady, National Business Leader – Precision Diagnosis Solutions at Philips. “When you look at the scale of the VA population, even a single percentage point improvement translates into thousands of Veterans getting the right care at the right time.”
Historically, many prostate biopsies have been performed without advanced imaging, relying on systematic sampling rather than targeting suspicious lesions.
While adoption of pre-biopsy MRI has increased significantly in recent years, many patients still undergo biopsy without prior imaging – creating variability in care, missed opportunities for more precise, targeted diagnosis, and avoidable burden from negative biopsies that strain already overloaded pathology departments and add unnecessary costs to the health system.
“That’s an education issue as much as anything,” Coady said. “Veterans need to know they can and should ask for an MRI before biopsy.”
VA has already laid significant groundwork for a more coordinated model of prostate care.
Across the VA system, advanced imaging and targeted biopsy capabilities are already in place at scale. Based on current deployment data, approximately100 VA locations are equipped with MRI capabilities for prostate evaluation, while more than 75 sites utilize MRI/ultrasound fusion-guided biopsy platforms to precisely target suspicious lesions – an approach that studies have shown can improve detection of clinically significant prostate cancer by up to 30%compared with systematic TRUS biopsy alone².
Digital pathology adoption is also well underway, with approximately 55 VA locations utilizing digital pathology workflows – making VA one of the largest integrated digital pathology networks in the world. These capabilities, combined with emerging AI-enabled tools, are helping to facilitate remote slide review, improved collaboration and enhanced diagnostic support across the enterprise.
Individually, each of these technologies improves care. Together, they form a connected “rad-path” ecosystem that links radiology, urology and pathology into a single workflow. This shift is moving prostate cancer care from fragmented handoffs to integrated collaboration.
“When radiology, urology and pathology are all looking at the same data on the same platform, you create a much more comprehensive view of the patient,” Coady said. “Clinicians can clearly see what radiology identified – including lesion location and PIRADS score – where the urologist performed the biopsy, and how the pathologist classified the tissue, including cancer presence and Gleason grade group. Bringing these insights together reduces variability, shortens timelines and increases confidence in treatment decisions.”
In practical terms, that means a Veteran with an elevated PSA could receive a multiparametric MRI (mpMRI), have suspicious lesions mapped digitally[MJ1] (AI-supported with Quibim), undergo a targeted fusion biopsy and receive AI-assisted pathology review — with data flowing efficiently between specialists.
Instead of waiting weeks between disconnected appointments, care becomes coordinated and data driven.
Time to diagnosis is not just an operational metric; it’s also a human one.
Integrated digital workflows are enabling meaningful reductions in diagnostic turn around time by eliminating the need to physically transport glass slides for secondary review. In the VA, where cancer diagnoses typically require secondary pathology review, digital platforms allow that review to occur remotely and without delay.
As a result, sites utilizing digital pathology have been able to reduce time to diagnosis from weeks to days, improving both clinical efficiency and the patient experience during a critical point in the care journey.
“When you’re talking about cancer diagnosis, every day without clarity has an impact on mental health,” Coady noted. “If we can compress that timeline while improving accuracy, that’s a win for both clinical outcomes and patient peace of mind.”
The benefits are particularly meaningful for rural Veterans. Many live far from major VA medical centers and may rely on community providers. Digital image sharing and telehealth-enabled collaboration allow specialists to review cases remotely, ensuring access to expertise regardless of geography.
Artificial intelligence is playing an increasingly central role in this evolution – serving as both a clinical support tool and an efficiency multiplier across the care pathway.
In radiology, AI-enabled prostate MRI tools have demonstrated the ability to significantly reduce interpretation and lesion contouring time, with some studies showing reductions from approximately 15–20 minutes to just a few minutes per case³. By automating segmentation and highlighting suspicious regions, these tools help improve consistency while reducing the burden on radiologists.
In urology ,advanced software platforms are enabling more streamlined workflows by integrating imaging, lesion targeting and biopsy planning into a unified environment – helping clinicians move more efficiently from diagnosis to intervention.
On the pathology side, AI-assisted digital workflows are helping standardize Gleason grading and reduce interobserver variability. Early implementations of digital pathology platforms combined with AI (e.g., Ibex)have demonstrated meaningful improvements in efficiency and productivity – reporting up to a 37% productivity gain – along with faster case turnaround, reduced time to diagnosis, and increased diagnostic throughput4.
Importantly, these technologies are not designed to replace clinicians, but to augment them –providing better data, greater consistency and more time to focus on complex clinical decision-making.
Accuracy matters not only for detecting aggressive cancers, but also for avoiding unnecessary intervention. Some prostate tumors are slow-growing and may never threaten a patient’s life, while others require urgent treatment – and distinguishing between the two is critical. In today’s prostate cancer care, under- and over-staging can translate into meaningful rates of under- or overtreatment– reported to affect up to 40% of patients – making better risk stratification a high-stakes priority5.
Fusion-guided biopsy platforms map tissue samples in three dimensions, linking biopsy cores directly to MRI findings. When correlated with digital pathology results, clinicians can pinpoint the exact location and aggressiveness of cancer within the prostate.
That precision enables more personalized options – including active surveillance or focal therapy that treats only the cancerous region, rather than removing or radiating the entire gland.
The quality-of-life implications are substantial. Avoiding unnecessary radical prostatectomy can reduce the risk of incontinence and sexual dysfunction, and ease the uncertainty that can weigh heavily on Veterans and their families.
“Our goal is not just to detect cancer,” Coady said. “It’s to detect clinically significant cancer and treat it in the least invasive, most effective way possible.”
Unlike breast cancer screening, prostate cancer lacks a universally enforced, MRI-first national standard. Historically, reimbursement structures lagged behind clinical innovation, offering limited incentives for advanced imaging and targeted biopsy approaches.
However, evolving reimbursement policies and updated clinical guidelines are increasingly supporting the use of MRI-guided diagnostic pathways, which may help accelerate broader adoption over time.
Recent updates to Medicare reimbursement, including newly established prostate biopsy coding frameworks introduced in 2026, further reflect this shift – providing clearer pathways for reporting and valuing targeted, image-guided approaches.
Coady envisions a future where MRI becomes a routine component of prostate cancer evaluation for at-risk men, playing a role earlier in the diagnostic pathway – similar to how imaging has transformed screening in other cancers.
“Five to ten years from now, I believe we’ll look back and wonder why we ever did blind biopsies first,” he said. “The data is moving us toward a more intelligent, imaging-led pathway.”
By integrating imaging, biopsy guidance, digital pathology and AI into a unified enterprise framework, VA is building infrastructure that can support precision medicine across multiple disease states.
For an organization serving millions of Veterans – many of whom face elevated cancer risks – that foundation is transformative.
At scale, even modest improvements in detection rates, diagnostic accuracy and treatment selection could improve or save thousands of lives annually.
The technology may be advanced. The workflows may be complex. But the mission is simple: ensure that every Veteran receives faster answers, more accurate diagnoses and care tailored to their individual risk.
As Coady put it, “If we can connect the data, unite clinicians, and seamlessly link the entire patient journey end to end, we won’t just modernize prostate care – we’ll fundamentally improve it.”
1. https://www.nature.com/articles/s43018-026-01127-0
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC12444391/
3. https://consultqd.clevelandclinic.org/how-ai-is-changing-the-prostate-mri
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC12191725/
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