Editing Management of Localized Prostate Cancer (section)

===== <span style="color:#ff0000">Reclassification Biopsy</span> =====
* '''Repeat prostate biopsies over time are the cornerstone of active surveillance.'''
** The critical role of repeat prostate biopsy for successful identification of higher-risk disease during surveillance cannot be overemphasized.
* Biopsy re-classification on surveillance can be defined in terms of a greater extent of disease at biopsy and/or higher grade of disease at biopsy, both predictive of adverse features at radical prostatectomy
* '''Early “confirmatory” biopsy serves to limit the risk of clinical undergrading resulting from sampling'''
** '''Many advocate for this repeat biopsy within 3-6 months of diagnosis'''
*** Gleason grade changes and thus risk reclassification occur in 2.5-28% after the first repeat biopsy. These numbers are sensitive to selection criteria and biopsy technique.
* '''Serial prostate biopsies are variably performed from an annual basis to once every 3 to 4 years.'''
** The risk of disease reclassification continues over time while on surveillance, likely a result of both undersampling and true histologic disease progression in either tumor grade or volume.