Accurate risk stratification is essential to prevent over- and undertreatment in newly diagnosed prostate cancer (PCa). In a pilot study with 49 men (36 PCa patients, 13 controls), we integrated non-invasive data modalities collected in a real-world clinical setting: radiomics from multiparametric magnetic resonance imaging (T2/ADC index-lesion features), routine and extended serological parameters, multimodal liquid biopsy features (copy number variations, chromosomal instability, methylation, fragmentation in plasma/urinary cfDNA), plus clinical and lifestyle factors. Pairwise Spearman analyses revealed significant inter-modality correlations. Our holistic PCa characterization showed that imaging phenotypes reflect tumor stage and molecular aggressiveness: lower ADC metrics correlated inversely with genomic cfDNA features, while ADC/T2 lesion volumes correlated positively with molecular signals. These results indicate that routine imaging and serological data may capture systemic tumor biology. Our proof-of-concept demonstrates feasibility of combining multiple data modalities in real-world clinical workflows and supports developing integrative models for non-invasive PCa risk stratification.

The authors have declared no competing interest.

This work was realized through support by the German Federal Ministry for Economic Affairs and Climate Action (funding # 01MT21004A) and the Dieter Morszeck Foundation. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the ethical committee of the University of Heidelberg (Approval No. S-130/2021) and was performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to study inclusion.

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The data sets generated and analyzed during the current study are available from the corresponding author on reasonable request.