Inoue LYT, et al. - The risks for upgrading from a Gleason score (GS) of 6 or less to 7 or more across active surveillance (AS) studies after accounting for differences in surveillance intervals and competing treatments were determined. The tradeoffs of more versys less frequent biopsieswere compared. Varying risks were noted among men in different AS studies for biopsy upgrading after accounting for variable surveillance protocols and competing treatments. Similar consequences of more versus less frequent biopsies were reported across cohorts. The findings illustrated that biennial biopsies are an acceptable alternative to annual biopsies.