Enhanced ISUP grade prediction in prostate cancer using multi-center radiomics data

To explore the predictive value of radiomics features extracted from anatomical ROIs in differentiating the International Society of Urological Pathology (ISUP) grading in prostate cancer patients.

This study included 1,500 prostate cancer patients from a multi-center study. The peripheral zone (PZ) and central gland (CG, transition zone + central zone) of the prostate were segmented using deep learning algorithms and were defined as the regions of interest (ROI) in this study. A total of 12,918 image-based features were extracted from T2-weighted imaging (T2WI), apparent diffusion coefficient (ADC), and diffusion-weighted imaging (DWI) images of these two ROIs. Synthetic minority over-sampling technique (SMOTE) algorithm was used to address the class imbalance problem. Feature selection was performed using Pearson correlation analysis and random forest regression. A prediction model was built using the random forest classification algorithm. Kruskal-Wallis H test, ANOVA, and Chi-Square Test were used for statistical analysis.

A total of 20 ISUP grading-related features were selected, including 10 from the PZ ROI and 10 from the CG ROI. On the test set, the combined PZ + CG radiomics model exhibited better predictive performance, with an AUC of 0.928 (95% CI: 0.872, 0.966), compared to the PZ model alone (AUC: 0.838; 95% CI: 0.722, 0.920) and the CG model alone (AUC: 0.904; 95% CI: 0.851, 0.945).

This study demonstrates that radiomic features extracted based on anatomical sub-region of the prostate can contribute to enhanced ISUP grade prediction. The combination of PZ + GG can provide more comprehensive information with improved accuracy. Further validation of this strategy in the future will enhance its prospects for improving decision-making in clinical settings.