Observation (Active Surveillance) after initial diagnosis of low-risk prostate cancer is safe and becoming more wide spread. Active surveillance traditionally includes repeat prostate biopsies over time to verify the prostate cancer has not progressed to a more aggressive form. MRI currently is the most sensitive imaging to detect significant prostate cancers. There has been interest in trying to replace some follow up prostate biopsies on Active Surveillance with MRI. A recent study indicates that while MRI is able to detect some cancer progression, standard template prostate biopsies continue to add benefit, identifying more cancer progression than even the MRI did. Furthermore, clinical factors had similar ability to predict the presence of more aggressive cancer as MRI. Advancements in MRI technology are occurring every day, so improved detection may occur in the future, but currently it seems that repeat prostate biopsies are critical in Active Surveillance protocols.