MRMS-CNNFormer: A Novel Framework for Predicting the Biochemical Recurrence of Prostate Cancer on Multi-Sequence MRI.

Accurate preoperative prediction of biochemical recurrence (BCR) in prostate cancer (PCa) is essential for treatment optimization, and demands an explicit focus on tumor microenvironment (TME). To address this, we developed MRMS-CNNFormer, an innovative framework integrating 2D multi-region (intratumoral, peritumoral, and periprostatic) and multi-sequence magnetic resonance imaging (MRI) images (T2-weighted imaging with fat suppression (T2WI-FS) and diffusion-weighted imaging (DWI)) with clinical characteristics. The framework utilizes a CNN-based encoder for imaging feature extraction, followed by a transformer-based encoder for multi-modal feature integration, and ultimately employs a fully connected (FC) layer for final BCR prediction. In this multi-center study (46 BCR-positive cases, 186 BCR-negative cases), patients from centers A and B were allocated to training (n = 146) and validation (n = 36) sets, while center C patients (n = 50) formed the external test set. The multi-region MRI-based model demonstrated superior performance (AUC, 0.825; 95% CI, 0.808-0.852) compared to single-region models. The integration of clinical data further enhanced the model's predictive capability (AUC 0.835; 95% CI, 0.818-0.869), significantly outperforming the clinical model alone (AUC 0.612; 95% CI, 0.574-0.646). MRMS-CNNFormer provides a robust, non-invasive approach for BCR prediction, offering valuable insights for personalized treatment planning and clinical decision making in PCa management.