Embodiments predict prostate cancer (PCa) biochemical recurrence (BCR) employing an image acquisition circuit that accesses a first pre-treatment image and a second pre-treatment image of a region of tissue demonstrating PCa, a distension feature circuit that extracts a set of distension features from the first pre-treatment image, and computes a first probability of PCa BCR based on the set of distension features, a radiomics circuit that extracts a set of radiomics features from the second pre-treatment image, and computes a second probability of PCa recurrence based on the set of radiomics feature, a combined tumor induced organ distension with tumor radiomics (COnTRa) circuit that computes a joint probability that the region of tissue will experience PCa BCR based on the first probability and the second probability, and a display circuit that displays the joint probability.