When a patient arrives for a second opinion on active surveillance, the number that gets quoted is the grade group. The number that decides whether the grade group means anything is how the biopsy was taken.
A systematic 12-core biopsy with targeted cores of any PI-RADS 3 or higher lesion is a different test from six systematic cores taken without imaging, and a grade group 1 from the second does not carry the same reassurance. Ask how many cores, whether an MRI preceded it, whether any lesion was targeted, and how many cores were positive with what percentage involvement.
Write the answers in the surveillance plan, not just in the clinic letter. The whole logic of surveillance is comparing this biopsy with the next one, and a comparison between two differently performed biopsies produces apparent progression that is really a change in sampling.
- Record core count, targeting and whether MRI preceded every surveillance biopsy
- A grade group 1 from an untargeted six-core biopsy is weaker reassurance than from a targeted 12-core
- Note the number of positive cores and percentage involvement, not just the grade group
- Keep the sampling method consistent between surveillance biopsies where possible
- Apparent progression between differently performed biopsies may be sampling, not biology
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