Predicting prostate cancer in men with PSA levels of 4–10 ng/mL: MRI-based radiomics can help junior radiologists improve the diagnostic performance

To develop MRI-based radiomics model for predicting prostate cancer (PCa) in men with prostate-specific antigen (PSA) levels of 4–10 ng/mL, to compare the performance of radiomics model and PI-RADS v2.1, and to further verify the predictive ability of radiomics model for lesions with different PI-RADS v2.1 score. 171 patients with PSA levels of 4–10 ng/mL were divided into training (n = 119) and testing (n = 52) groups. PI-RADS v2.1 score was assessed by two radiologists. All volumes of interest were segmented on T(2)-weighted imaging, diffusion weighted imaging, and apparent diffusion coefficient sequences, from which quantitative radiomics features were extracted. Multivariate logistic regression analysis was performed to establish radiomics model for predicting PCa. The diagnostic performance was assessed using receiver operating characteristic curve analysis. The radiomics model exhibited the best performance in predicting PCa, which was better than the performance of PI-RADS v2.1 scoring by the junior radiologist in the training group [area under the curve (AUC): 0.932 vs 0.803], testing group (AUC: 0.922 vs 0.797), and the entire cohort (AUC: 0.927 vs 0.801) (P < 0.05). The radiomics model performed well for lesions with PI-RADS v2.1 score of 3 (AUC = 0.854, sensitivity = 84.62%, specificity = 84.34%) and PI-RADS v2.1 score of 4–5 (AUC = 0.967, sensitivity = 98.11%, specificity = 86.36%) assigned by junior radiologist. The radiomics model quantitatively outperformed PI-RADS v2.1 for noninvasive prediction of PCa in men with PSA levels of 4–10 ng/mL. The model can help improve the diagnostic performance of junior radiologists and facilitate better decision-making by urologists for management of lesions with different PI-RADS v2.1 score.