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We estimated prostate cancer growth rate accounting for individual variation in a longitudinal AS cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We modelled tumour growth in 145 biopsy-confirmed prostate cancer patients undergoing MRI-based AS. Primary lesion volumes were measured longitudinally using planimetry. We compared three mixed-effects models (exponential, Gompertz, and logistic) and investigated relationships between growth rate and clinical characteristics. We estimated the natural trajectory of prostate cancer lesions starting at a single cell to clinical detectability (diameter \u2248 1\u2009cm), with diameters estimated based on spherical volume.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All three models fit observed data well; however, only the Gompertz model provided reasonable estimates from a single cell to an MRI-detectable size (diameter \u2248 3\u2009mm). The Gompertz growth parameter (mean = 0.07, range = 0.02\u20130.15), describing exponential growth deceleration, was positively correlated with: patient age; lesion volume at AS onset; prostate-specific antigen (PSA) level; and PSA density. Lesions with Gleason 3\u2009+\u20094 had faster volume doubling times than Gleason 3\u2009+\u20093 lesions (mean = 3.5 and 5.2 years, respectively). On average, it would take 17 years (95% CI [15, 19]) for a lesion to grow from a single cell to an MRI-detectable size and an additional 12 years to reach a clinically detectable size (95% CI [10, 13]). At age 50, 75% of lesions would remain undetectable by MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prostate cancer shows slow growth with large variation between patients, posing a challenge for early detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>What is the population distribution of growth rates and the natural history of prostate cancer?<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Prostate cancer typically grows slowly, with considerable variation between individuals. On average, lesions take 17 years to grow from initiation to an MRI-detectable size.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Small lesions undetectable on MRI may take many years to reach a clinically significant size, posing a challenge for early detection, as it increases the risk of detecting indolent lesions that may never cause harm.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12248-y","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T14:34:28Z","timestamp":1768574068000},"page":"5094-5105","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Variation in prostate cancer growth rates in an MRI-based active surveillance cohort"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3636-9857","authenticated-orcid":false,"given":"Hayley","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilis","family":"Stavrinides","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giganti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline M.","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharath","family":"Narayanan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Emberton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul D. 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They are also a member of the Scientific Editorial Board of\n                      European Radiology\n                      (Section: Urogenital) and the Guest Editor of the Active Surveillance of Prostate Cancer: MRI and Beyond collection; as such, he has not participated in the selection or review processes for this article. Caroline M. Moore receives study funding from SpectraCure and has received speaker fees from Astellas, Ipsen, Janssen, and Bayer. Mark Emberton is a consultant to Sonacare Inc., Angiodynamics Inc., NINA Medical, Early Health Ltd, and Albermarle Bioscience Ltd. All other authors declare no conflicts of interest or competing interests relevant to the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical experience.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was not required for our analysis as all data were anonymised in a previous study. At the institution at which the data were collected, all clinical records and MR images are routinely reviewed as part of an audit performed for the internal evaluation of the AS service as per UK NICE guidelines.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was not required for our analysis. Approval was not required for the AS cohort because at the institution at which the data were collected, all clinical records and MR images are routinely reviewed as part of an audit performed for the internal evaluation of the AS service as per UK NICE guidelines.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This cohort has been previously reported in Giganti et al [\n                      \n                      ].","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}