Prediction of clinically significant prostate cancer using radiomics models in real-world clinical practice: a retrospective multicenter study

To develop and evaluate machine learning models based on MRI to predict clinically significant prostate cancer (csPCa) and International Society of Urological Pathology (ISUP) grade group as well as explore the potential value of radiomics models for improving the performance of radiologists for Prostate Imaging Reporting and Data System (PI-RADS) assessment. A total of 1616 patients from 4 tertiary care medical centers were retrospectively enrolled. PI-RADS assessments were performed by junior, senior, and expert-level radiologists. The radiomics models for predicting csPCa were built using 4 machine-learning algorithms. The PI-RADS were adjusted by the radiomics model. The relationship between the Rad-score and ISUP was evaluated by Spearman analysis. The radiomics models made using the random forest algorithm yielded areas under the receiver operating characteristic curves (AUCs) of 0. 874, 0. 876, and 0. 893 in an internal testing cohort and external testing cohorts, respectively. The AUC of the adjustedPI-RADS was improved, and the specificity was improved at a slight sacrifice of sensitivity. The participant-level correlation showed that the Rad-score was positively correlated with ISUP in all testing cohorts (r > 0. 600 and p < 0. 0001). This radiomics model resulted as a powerful, non-invasive auxiliary tool for accurately predicting prostate cancer aggressiveness. The radiomics model could reduce unnecessary biopsies and help improve the diagnostic performance of radiologists' PI-RADS. Yet, prospective studies are still needed to validate the radiomics models further. The radiomics model with MRI may help to accurately screen out clinically significant prostate cancer, thereby assisting physicians in making individualized treatment plans. • The diagnostic performance of the radiomics model using the Random Forest algorithm is comparable to the Prostate Imaging Reporting and Data System (PI-RADS) obtained by radiologists. • The performance of the adjusted Prostate Imaging Reporting and Data System (PI-RADS) was improved, which implied that the radiomics model could be a potential radiological assessment tool. • The radiomics model lowered the percentage of equivocal cases. Moreover, the Rad-scores can be used to characterize prostate cancer aggressiveness.