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We evaluated the inter- and intra-rater reliability (reliability between different radiologists and the same radiologist during different reading sessions) of lesion size measurements on baseline MRI scans for patients on active surveillance (AS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Twenty patients with low- or intermediate-risk PCa (Gleason score 3\u2009+\u20093 or 3\u2009+\u20094) and MRI-visible lesions were selected from AS cohorts at two centres (United Kingdom and Italy). Five radiologists, blinded to clinical outcomes and reports, independently measured the index lesion on a\u00a0baseline MRI scan\u00a0in a single reading\u00a0session using: (1) maximum diameter; (2) biaxial diameters; (3) ellipsoid volume, and (4) planimetry volume. Measurements were repeated after a 4-week washout period. Strip plots present lesion size measurements for all methods and readers. Bland\u2013Altman plots were used to present intra-rater reliability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Graphical presentation of measurements across the twenty patients enabled examination of variability between methods, readers, and reads. There was considerable variation for all methods, and for a single lesion, size measurements spanned previously accepted definitions of clinically significant and insignificant disease. Inter-rater reliability decreased for larger lesions, with notable radiologist-specific differences, and intra-rater reliability appeared better overall.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study underscores the difficulty of reliably measuring PCa lesions during AS. Intra-rater reliability appeared greater than inter-rater reliability, emphasising that radiologists should remeasure lesions when tracking changes. More work is needed on measuring change in lesion size across serial MRI scans.<\/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>Several methods exist for measuring prostate cancer lesion size on MRI for patients on active surveillance, but it is unclear how reliable these methods are<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Lesion size measurements varied widely across methods and readers, often spanning thresholds for clinically significant disease, and intra-rater reliability was generally better than inter-rater reliability<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Variability in lesion size measurements on MRI may lead to inconsistent clinical decisions during active surveillance. Our findings emphasise that regardless of the method used, lesions should be remeasured by the same radiologist when monitoring patients on active surveillance<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12318-1","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T17:15:05Z","timestamp":1770398105000},"page":"5706-5718","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Inter- and intra-rater variability of MRI-based lesion size measurements in active surveillance for prostate cancer: a multicentre study"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8922-2376","authenticated-orcid":false,"given":"Cameron","family":"Englman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Busola","family":"Adebusoye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Cosenza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Del Prete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Dickinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Imperiale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Leni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Gandaglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"De Cobelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Mallett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Kirkham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline M.","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giganti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Brembilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"12318_CR1","doi-asserted-by":"crossref","unstructured":"Englman C, Barrett T, Moore CM, Giganti F (2023) Active surveillance for prostate cancer: expanding the role of MR imaging and the use of PRECISE criteria. 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Moore.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"Caroline M. Moore is an NIHR research professor; she receives grant funding from the Medical Research Council, Cancer Research UK, Movember, Prostate Cancer UK, and the EAU Foundation; she receives study funding from SpectraCure; she has received speaker fees from Astellas, Ipsen, Janssen, and Bayer. Francesco Giganti reports consulting fees from DeepHealth, SpectraCure and Procept outside of the submitted work; he has received speaker fees from Bayer and Siemens. He is\u00a0also a member of the Scientific Editorial Board of\n                      European Radiology\n                      (section: Urogenital) and is the guest editor for the \u201cActive surveillance of prostate cancer: MRI and beyond\u201d series in\n                      European Radiology\n                      \u2014as such, he has not participated in the selection or review processes for this article. All other authors declare no conflict of interests and competing interests relevant to the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Professor Sue Mallett, a Professor of Diagnostic and Prognostic Medical Statistics at University College London, and Busola Adebusoye, a statistician and postdoctoral researcher at University College London, provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was not required because the study used anonymised clinical records and magnetic resonance imaging scans collected during routine care and service evaluation, with no impact on patient management.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board or Research Ethics Committee approval was not required because clinical records and magnetic resonance imaging scans were routinely reviewed as part of an audit performed for service evaluation of the active surveillance programme at each centre.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Some study subjects have been previously reported in publications describing the University College London Hospitals and San Raffaele Hospital active surveillance cohorts.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}