ObjectiveTo establish machine learning (ML) prediction models for prostate cancer (PCa) using transrectal ultrasound videos and multi-parametric magnetic resonance imaging (mpMRI) and compare their diagnostic performance.Materials and methodsWe systematically collated the data of 383 patients, including 187 with PCa and 196 with benign lesions. Of them, 307 patients (150 with PCa and 157 with benign lesions) were randomly selected to train and validate the ML models, 76 patients were used as test set. B-Ultrasound videos (BUS), mpMRI T2 sequence (T2), and ADC sequence (ADC) were obtained from all patients. We extracted 851 features of each patient in the BUS, T2, and ADC groups and used a t-test, the Mann–Whitney U test, and LASSO regression to screen the features. Support vector machine (SVM), random forest (RF), adaptive boosting (ADB), and gradient boosting machine (GBM) models were used to establish radiomics models. In addition, we fused the features screenedviaLASSO regression from three groups as new features and rebuilt ML models. The performance of the ML models in diagnosing PCa in the BUS, T2, ADC, and fusion groups was compared using the area under the ROC curve (AUC), sensitivity, specificity, and accuracy.ResultsIn the test cohort, the AUC of each model in the ADC group was higher than that of in the.BUS and T2 groups. Among the models, the RF model had the best diagnostic performance, with an AUC of 0.85, sensitivity of 0.78 (0.61–0.89), specificity of 0.84 (0.69–0.94), and accuracy of 0.83 (0.66–0.93). The SVM model in both the BUS and T2 groups performed best. Based on the features screened in the BUS, T2, and ADC groups fused to construct the models, the SVM model was found to perform best, with an AUC of 0.87, sensitivity of 0.73 (0.56–0.86), specificity of 0.79 (0.63–0.90), and accuracy of 0.77 (0.59–0.89). The difference in the results was statistically significant (p<0.05).ConclusionThe ML prediction models had a good diagnostic ability for PCa. Among them, the SVM model in the fusion group showed the best performance in diagnosing PCa. These prediction models can help radiologists make better diagnoses.