PURPOSE: With the growing adoption of active surveillance clinical parameters that can tailor the intensity of monitoring are increasingly needed. Therefore, we aimed to evaluate the prognostic value of negative followup biopsy for reclassification and upgrading in prostate cancer patients managed with active surveillance. MATERIALS AND METHODS: The PubMed®, Web of ScienceTM, and Scopus® databases were queried to identify relevant studies published until November 2020 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. We performed a formal meta-analysis for the reclassification and upgrading in the full cohort and selected subgroups. RESULTS: We identified 13 and 9 studies eligible for the systematic review and meta-analysis, respectively. A total of 2,628 patients were included in the meta-analysis. Any negative followup biopsy was associated with significantly lower risk of reclassification (HR 0.46, 95% CI 0.39-0.55; p <0.01), and upgrading (HR 0.54, 95% CI 0.44-0.66; p <0.01). For the confirmatory biopsy subgroup, the results remained significant for reclassification (HR 0.44, 95% CI 0.36-0.55; p <0.01) and upgrading (HR 0.55, 95% CI 0.42-0.73; p <0.01). These patterns remained robust among patients with only Gleason Grade prognostic group 1 (reclassification HR 0.47, 95% CI 0.39-0.57; p <0.01; upgrading HR 0.54, 95% CI 0.42-0.69; p <0.01). CONCLUSIONS: A negative followup biopsy is associated with an approximately 50% decrease in the risk of future reclassification and upgrading. Incorporation of the negative followup biopsy into current protocols should allow for personalized active surveillance tailoring and more precise decision making.

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology La Croix du Sud Hospital Quint Fonsegrives France

Department of Urology Medical University of Silesia Zabrze Poland

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology University of Texas Southwestern Dallas Texas

Department of Urology Weill Cornell Medical College New York New York

Department of Urology Yale School of Medicine New Haven Connecticut

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

J Urol. 2022 Jan;207(1):242. doi: 10.1097/JU.0000000000002245. PubMed

Citace poskytuje Crossref.org

Prostate cancer risk, screening and management in patients with germline BRCA1/2 mutations