MRI Radiomics Model Distinguishes Gleason ≤3+4 from ≥4+3 Prostate Cancer with External AUC 0.795

Combined clinical and peritumoral T2WI radiomics model: external validation AUC 0.795 (95% CI 0.694–0.895) for predicting Gleason ≥4+3 vs ≤3+4 in 225 patients (retrospective, multicenter). Core radiomic feature partially mediated the PI-RADS to Gleason score relationship (indire…

• Multicenter retrospective cohort of 225 prostate cancer patients with T2-weighted MRI; intratumoral and peritumoral radiomic features extracted.
• Best model integrated clinical variables and IntraPeri_1mm features; training AUC 0.975, internal test 0.854, external validation 0.795.
• SHAP analysis revealed a core feature correlating with aggressive indicators and partially mediating PI-RADS effect on Gleason score.

Retrospective design; external AUC lower than training, consistent with possible overfitting; no comparison with radiologist interpretation.

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