Association of Negative Followup Biopsy and Reclassification during Active Surveillance of Prostate Cancer: A Systematic Review and Meta-Analysis

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 (R), Web of Science (TM), and Scopus (R) data-bases 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.