A multi-architecture study of specificity refinement and false-positive mechanism analysis in prostate MRI

Magnetic Resonance Imaging (MRI) is vital for prostate cancer (PCa) diagnosis. While advanced techniques such as Hybrid Multi-dimensional MRI (HM-MRI) have enhanced diagnostic capabilities, the significant need remains for robust, automated Artificial Intelligence (AI)-based detection methods. In this study, we combine quantitative HM-MRI of tissue composition with an AI-based neural network. We propose the Hadamard-Bias Network plus ResNet18 (HBR-Net-18), a two-stage AI framework for PCa detection. In the first stage, a Hadamard U-Net-based algorithm suppresses intensity inhomogeneities (bias fields) across six parametric HM-MRI maps generated via a Physics-Informed Autoencoder (PIA). In the second stage, a Residual Network (ResNet-18) performs patch-level classification. The framework utilizes overlapping 11-by-11 patches, incorporating both 2D intra-slice and 3D inter-slice (adjacent-slice) information to improve spatial consistency. Our experimental results demonstrate that HB-Net achieves balanced sensitivity and specificity, significantly outperforming conventional radiomics-based approaches and baseline CNN models, highlighting its potential for clinical deployment.

Prostate cancer diagnosis with multiparametric MRI (mpMRI) is commonly based on PI-RADS assessment or binary classification, which suffer from subjectivity and fail to capture clinically relevant pathological heterogeneity. To address this limitation, we construct a Prostate Cancer Histopathology Spectrum Dataset (PCa-HSD) and formulate a clinically meaningful four-class classification task, addressing the underrepresentation of benign lesions that are easily confounded with prostate cancer in existing datasets. We propose Language-guided Segmentation-assisted Diagnostic Transformer model (LSDT), which leverages zero-shot segmentation to provide anatomical priors and performs effective multi-modal slice fusion for classification. Our proposed method consistently improves accuracy across backbones, achieving the best average accuracy of 0.633 and JointRecall of 0.768 in five-fold cross-validation on a cohort of 344 patients. These results demonstrate that integrating pathology supervision and anatomical priors significantly enhances fine-grained prostate MRI classification and provides a more clinically relevant paradigm for risk stratification. Code will be made publicly available in a future revision.

Micro-ultrasound ($μ$US) is a new, emerging, and promising imaging modality for prostate cancer (PCa) detection, but accurate identification of suspicious tissue remains highly dependent on clinical experience, leading to substantial inter-observer variability. Machine-learning assistance can reduce this variability; however, training reliable deep models is challenging because supervision is sparse and noisy -- typically limited to core-level histopathology outcomes (e.g., cancer grade and its percentage in a biopsy core) without pixel-level lesion annotations and under severe class imbalance. We introduce Prost-RL, which reframes $μ$US PCa detection as a spatially aware, policy-driven inference problem by learning where to look before decoding. Prost-RL integrates a lightweight reinforcement-learning policy into a foundation-model encoder-decoder to generate interpretable spatial attention maps that act as soft prompts for both cancer-likelihood heatmap prediction and image-level classification. We further propose Adaptive Policy Optimization (APO) to stabilize hybrid supervised-RL training and a noise-robust objective combining symmetric cross-entropy with negative-entropy regularization to mitigate weak-label noise and encourage sharp localization. On a cohort of 6,607 biopsy cores from 693 patients across five clinical sites, Prost-RL achieves $79.0\pm3.5$ AUROC with $64.6\pm6.3$% sensitivity at 80% specificity for core-level detection (+2.1 AUROC and +4.5 sensitivity points over the strongest baseline), and $79.3\pm5.8$ AUROC for clinically significant cancer classification. The learned policy highlights biopsy-aligned regions, providing transparent, spatially grounded evidence alongside quantitative risk predictions. Code is available at: https://github.com/DeepRCL/Prost-RL.