Serial MRI allows for non-invasive monitoring of prostate cancer patients on Active Surveillance (AS). However, repeat biopsies continue to be defacto standard for AS monitoring due to limitations of MRI. In this study, we sought to compute delta changes in radiomic features on serial bi-parametric MRI and evaluate their associations with biopsy upgrading. We observed that delta radiomic features that quantify underlying spatial, gradient based heterogeneity were associated with biopsy upgrading. On univariable and multivariable analysis with routine clinical variables, we observed that none of the clinical variables were significant while delta radiomic classifier predictions were significant and independently predictive.
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