# Deep Learning Based Computer-Aided Detection of Prostate Cancer Metastases in Bone Scintigraphy: An Experimental Analysis

## TL;DR

This study compares different deep learning models for detecting prostate cancer metastases in bone scans and finds that DenseNet121 offers the best balance of accuracy and efficiency.

## Contribution

The paper experimentally evaluates 14 CNN architectures for metastasis detection in bone scintigraphy, identifying DenseNet121 as the most reliable and deployable model.

## Key findings

- DenseNet121 achieved the best diagnostic performance with AUC-ROC of 96.0 ± 1.2 and strong calibration.
- DenseNet121-attention had the highest AUC-ROC but showed variability in specificity.
- Heavier models provided limited additional clinical value compared to DenseNet121.

## Abstract

Bone scintigraphy is a widely available and cost-effective modality for detecting skeletal metastases in prostate cancer, yet visual interpretation can be challenging due to heterogeneous uptake patterns, benign mimickers, and a high reporting workload, motivating robust computer-aided decision support. In this study, we present an experimental evaluation of fourteen convolutional neural network (CNN) architectures for binary metastasis classification in planar bone scintigraphy using a unified protocol. Fourteen models, CNN (baseline), AlexNet, VGG16, VGG19, ResNet18, ResNet34, ResNet50, ResNet50-attention, DenseNet121, DenseNet169, DenseNet121-attention, WideResNet50_2, EfficientNet-B0, and ConvNeXt-Tiny, were trained and tested on 600 scan images (300 normal, 300 metastatic) from the Jordanian Royal Medical Services under identical preprocessing and augmentation with stratified five-fold cross-validation. We report mean ± SD for AUC-ROC, accuracy, precision, sensitivity (recall), F1-score, specificity, and Cohen’s κ, alongside calibration via the Brier score and deployment indicators (parameters, FLOPs, model size, and inference time). DenseNet121 achieved the best overall balance of diagnostic performance and reliability, reaching AUC-ROC 96.0 ± 1.2, accuracy 89.2 ± 2.2, sensitivity 83.7 ± 3.4, specificity 94.7 ± 2.2, F1-score 88.5 ± 2.5, κ = 0.783 ± 0.045, and the strongest calibration (Brier 0.080 ± 0.013), with stable fold-to-fold behaviour. DenseNet121-attention produced the highest AUC-ROC (96.3 ± 1.1) but exhibited greater variability in specificity, indicating less consistent false-alarm control. Complexity analysis supported DenseNet121 as deployable (~7.0 M parameters, ~26.9 MB, ~92 ms/image), whereas heavier models yielded only limited additional clinical value. These results support DenseNet121 as a reliable backbone for automated metastasis detection in planar scintigraphy, with future work focusing on external validation, threshold optimisation, interpretability, and model compression for clinical adoption.