A Prostate Cancer Case Study
- Aug 13
- 3 min read
By Dr Ezam Mat Ali, FRCPCH BMBS MA (Technology in Clinical Practice)
CEO of MedPlanner
Every scan was negative, but the cancer was active
I want to share something that happened to me recently, because it has stayed with me.
I was at a wedding. Seated next to me was a gentleman of 71. We fell into the easy conversation that weddings invite, and before long he told me something he was clearly carrying. Years ago he had been treated for node-positive prostate cancer. Surgery, radiation, and two years of hormone therapy. He did the hard part, and he did it well. His PSA dropped to almost nothing and stayed flat for a long time.
Then, over the last couple of years, it had started to climb. Slowly at first. Then not so slowly. By now his PSA had reached 15. He was in recurrence after a long remission, and although he had an excellent oncologist and an excellent urologist, the two of them were finding it genuinely difficult to agree on the best way forward.
Here is what made his case so hard. Every scan was clean. PSMA PET, negative. FDG PET, negative. MRI, negative. Bone scan, negative. A number that said the cancer was active, and imaging that said it was not. As he described it, one of his specialists had told him he had never seen a PSA of 15 with a completely negative PSMA scan.
He asked me what I did for a living. I told him I am the CEO of HEMI (by MedPlanner), and that we have built an AI based solution for doctors called HEMI Health. Something in that landed with him. He reached for his phone and showed me the correspondence between his oncologist, his urologist and himself, along with all of his medical reports.
I asked him whether he would like HEMI Health to support his doctors by bringing together the information on how his case might best be managed. He was genuinely excited at the idea, and there and then he forwarded me everything.
Sitting beside him, I ran it through HEMI.
In minutes, not hours, the relevant evidence was on the table, sourced and structured:
• Why a rising PSA can stay invisible on PSMA PET. Poorly differentiated or neuroendocrine disease can stop expressing the PSMA target, which also means PSMA-directed therapy is not the answer for this patient.
• Which trial pathways actually applied. A pathway several people had suggested did not fit him. His node-positive disease from the outset excluded him, a detail easy to miss in the moment.
• What the guidelines supported. The evidence pointed towards treatment intensification, combining hormonal and androgen-receptor-targeted therapy, rather than watchful waiting or single-agent treatment.
I sent the HEMI output back to him. He, in turn, shared it with his oncologist and his urologist.
Their response is what has stayed with me most. They were genuinely impressed. They found the output supportive and practical, and it gave them the confidence to move forward with managing his condition. What reassured them was not that a machine had made the decision, because it had not. It was that the recommendations were clearly structured, drew on the experience they already had, and above all were backed by citations and by every relevant piece of literature available. They felt confident, and they felt medicolegally protected, because the reasoning behind each recommendation was transparent, evidenced and defensible.
None of this replaced the clinicians. It did the opposite. It meant the urologist and the oncologist came to their discussion already briefed, working from the same evidence base, spending their time on judgement rather than on retrieval. The conversation did not start at “let me check.” It started at the decision. And they reached one. A plan the treating team could stand behind and defend, arrived at in a fraction of the time these cases usually take.
That is the part worth sitting with. HEMI did not diagnose. It did not prescribe. It made sure that when the experts sat down together, the evidence was already in the room. Accurate, cited, and fast enough to keep pace with a rising PSA that was not going to wait.
This is what we mean by evidence-backed clinical decision support. Not a machine making the call, but expert humans making a better call, sooner, because the homework was done before the meeting began.
Written by Dr Ezam Mat Ali
Founder and CEO of HEMI (Health Medical Intelligence)
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