Embodiments discussed herein facilitate determining a diagnosis and/or prognosis for prostate cancer based at least in part on three-dimensional (3D) pathomic feature(s). One example embodiment comprises a computer-readable medium storing computer-executable instructions that, when executed, cause a processor to perform operations, comprising: accessing a three-dimensional (3D) optical image volume comprising a prostate gland of a patient; segmenting the prostate gland of the 3D optical image volume; extracting one or more features from the segmented prostate gland, wherein the one or more features comprise at least one 3D pathomic feature; and generating, via a model based at least on the one or more features, one or more of the following based at least on the extracted one or more features: a classification of the prostate gland as one of benign or malignant, a Gleason score associated with the prostate gland, or a prognosis for the patient.