Deep Learning From Routine Histology Improves Risk Stratification for Biochemical Recurrence in Prostate Cancer

Clément Grisi; Khrystyna Faryna; Nefise Uysal; Vittorio Agosti; Enrico Munari; Solène-Florence Kammerer-Jacquet; Paulo Guilherme de Oliveira Salles; Yuri Tolkach; Reinhard Büttner; Sofiya Semko; Maksym Pikul; Axel Heidenreich; Jeroen van der Laak; Geert Litjens

arXiv · 2603.14187

Deep Learning From Routine Histology Improves Risk Stratification for Biochemical Recurrence in Prostate Cancer

Clément Grisi·Khrystyna Faryna·Nefise Uysal·Vittorio Agosti·Enrico Munari·Solène-Florence Kammerer-Jacquet·Paulo Guilherme de Oliveira Salles·Yuri Tolkach·Reinhard Büttner·Sofiya Semko·Maksym Pikul·Axel Heidenreich·Jeroen van der Laak·Geert Litjens

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Abstract

Accurate prediction of biochemical recurrence (BCR) after radical prostatectomy is critical for guiding adjuvant treatment and surveillance decisions in prostate cancer. However, existing clinicopathological risk models reduce complex morphology to relatively coarse descriptors, leaving substantial prognostic information embedded in routine histopathology underexplored. We present a deep learning-based biomarker that predicts continuous, patient-specific risk of BCR directly from H&E-stained whole-slide prostatectomy specimens. Trained end-to-end on time-to-event outcomes and evaluated across four independent international cohorts, our model demonstrates robust generalization across institutions and patient populations. When integrated with the CAPRA-S clinical risk score, the deep learning risk score consistently improved discrimination for BCR, increasing concordance indices from 0.725-0.772 to 0.749-0.788 across cohorts. To support clinical interpretability, outcome-grounded analyses revealed subtle histomorphological patterns associated with recurrence risk that are not captured by conventional clinicopathological risk scores. This multicohort study demonstrates that deep learning applied to routine prostate histopathology can deliver reproducible and clinically generalizable biomarkers that augment postoperative risk stratification, with potential to support personalized management of prostate cancer in real-world clinical settings.

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Clément Grisi, Khrystyna Faryna, Nefise Uysal, Vittorio Agosti, Enrico Munari, Solène-Florence Kammerer-Jacquet, Paulo Guilherme de Oliveira Salles, Yuri Tolkach, Reinhard Büttner, Sofiya Semko, Maksym Pikul, Axel Heidenreich, Jeroen van der Laak, Geert Litjens. 2026-03-15. Deep Learning From Routine Histology Improves Risk Stratification for Biochemical Recurrence in Prostate Cancer. https://arxiv.org/abs/2603.14187

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