An MRI-pathology foundation model for noninvasive diagnosis and grading of prostate cancer.

Prostate cancer is a leading health concern for men, yet current clinical assessments of tumor aggressiveness rely on invasive procedures that often lead to inconsistencies. There remains a critical need for accurate, noninvasive diagnosis and grading methods. Here we developed a foundation model trained on multiparametric magnetic resonance imaging (MRI) and paired pathology data for noninvasive diagnosis and grading of prostate cancer. Our model, MRI-based Predicted Transformer for Prostate Cancer (MRI-PTPCa), was trained under contrastive learning on nearly 1.3 million image-pathology pairs from over 5,500 patients in discovery, modeling, external and prospective cohorts. During real-world testing, prediction of MRI-PTPCa demonstrated consistency with pathology and superior performance (area under the curve above 0.978; grading accuracy 89.1%) compared with clinical measures and other prediction models. This work introduces a scalable, noninvasive approach to prostate cancer diagnosis and grading, offering a robust tool to support clinical decision-making while reducing reliance on biopsies.