Organizations: College of Artificial Intelligence, Nankai University, Tianjin 300350, China · Tianjin First Central Hospital, Tianjin 300382, China · School of Electronics and Information Engineering, Tiangong University, Tianjin 300387, China · School of Artificial Intelligence, Hebei University of Technology, Tianjin 300401, China · North China Digital Health Technology Co., Ltd., Jinan 250117, China · School of Computing and Information Systems, Singapore Management University, Singapore 178902, Singapore
Abstract
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.
Biochemical recurrence (BCR) after radical prostatectomy is a critical endpoint in prostate cancer, yet risk stratification relies almost entirely on variables dominated by Gleason grade. Whether H&E whole slide images (WSIs) carry prognostic signal beyond grade, and whether multiple instance learning (MIL) can recover it, remains unsettled. A key obstacle is that many pipelines select model checkpoints on the evaluation fold, artificially inflating concordance. We construct a rigorous benchmark on TCGA-PRAD (487 patients, 101 BCR events) using strict out-of-fold scoring over five-fold cross-validation repeated across five seeds. The choice of MIL aggregator (ABMIL, CLAM, TransMIL, PatchGCN) has little effect (C-index 0.61-0.64 with UNI2-h), while the feature extractor is the dominant factor (ResNet50 0.566 versus pathology foundation models up to 0.639). A clinical Cox model on grade, stage, and age reaches 0.687; no imaging-only model significantly outperforms it (p > 0.10). We introduce Grade-Disentangled MIL (GD-MIL), a gated-attention MIL encoder trained with a gradient-reversal grade adversary that encourages the slide representation to be invariant to Gleason grade before late fusion with clinical variables. GD-MIL achieves C-index 0.704, significantly outperforming both the clinical baseline (delta-c = +0.029, p = 0.0005) and the best imaging-only model (delta-c = +0.062, p = 0.039), suggesting H&E morphology contains prognostic information complementary to grade. A median risk split yields log-rank p < 0.0001 separation in BCR-free survival (~20% vs ~70% at five years).
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.
Emadeldeen Hamdan, Gorkem Durak, Muhammed Enes Tasci +7
Automated 3D segmentation of prostate lesions from biparametric MRI (bp-MRI) is essential for reliable algorithmic analysis, but achieving high precision remains challenging. Volumetric methods must combine multiple modalities while ensuring anatomical consistency, but current models struggle to integrate cross-modal information reliably. While vision-language models (VLMs) are replacing the currently used architectural designs, they still lack the fine-grained, lesion-level semantics required for effective localized guidance. To address these limitations, we propose a new multi-encoder U-Net architecture incorporating three key innovations: (1) an alignment loss that enhances foreground text-image similarity to inject lesion semantics; (2) a heatmap loss that calibrates the similarity map and suppresses spurious background activations; and (3) a final-stage, confidence-gated multi-head cross-attention refiner that performs localized boundary edits in high-confidence regions. A phase-scheduled training regime stabilizes the optimization of these components. Our method consistently outperforms prior approaches, establishing a new state-of-the-art on the PI-CAI dataset through enhanced multi-modal fusion and localized text guidance. Our code is available at https://github.com/NUBagciLab/Prostate-Lesion-Segmentation.