Reclassification of prostate cancer on first confirmatory prostate biopsy in men under active surveillance: A systematic review and meta-analysis.

Introduction: Prostate cancer is typically diagnosed following prostate biopsy. In low-risk and selected favourable intermediate-risk disease, active surveillance is the treatment strategy of choice. In these men, a confirmatory biopsy performed. We report on the rates of risk upgrading at biopsy confirmatory that may represent a need to pursue further treatment in lieu of active surveillance. Material and methods: We performed a systematic review and meta-analysis of pooled reclassification rates of men on active surveillance at first confirmatory biopsy, in line with PRISMA recommendations. PubMed, EMBASE, and Cochrane central registry for clinical trials were searched until June 2024. Stata was used to pool reclassification rates at first confirmatory biopsy. Results: Seventeen studies from 9 countries comprising 6,039 patients were included. Transrectal biopsy was the most common biopsy method for confirmatory biopsy. Weighted pooled rates of upgrading on first confirmatory biopsy were 20% with a 95% confidence interval of 19-21%. Conclusions: Approximately 20% of men undergoing active surveillance were upgraded at confirmatory biopsy. This may alter the management of these patients, and it highlights the importance of a confirmatory biopsy.