Mac Curtain Benjamin M, Daly Killian, Calpin Gavin, Collins Eoin, Deshwal Avinash, Lynch Olwyn, Qian Wanyang, O'Mahony Aaron, Temperley Hugo C, Mac Curtain Reuben D, Moran Diarmaid, Kelly John A O, Dowling Catherine
Department of Urology, St Vincent's University Hospital, Dublin, Ireland.
Department of Urology, University Hospital Galway, Galway, Ireland.
Cent European J Urol. 2025;78(2):125-136. doi: 10.5173/ceju.2025.0011. Epub 2025 May 26.
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.
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.
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%.
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.
前列腺癌通常在前列腺活检后被诊断出来。对于低风险和部分有利的中风险疾病，主动监测是首选的治疗策略。对于这些男性患者，需进行确诊性活检。我们报告了确诊性活检时风险升级的发生率，这可能意味着需要放弃主动监测而采取进一步治疗。
我们根据PRISMA建议，对首次确诊性活检时接受主动监测的男性患者的合并重新分类率进行了系统评价和荟萃分析。检索了截至2024年6月的PubMed、EMBASE和Cochrane临床试验中央注册库。使用Stata对首次确诊性活检时的重新分类率进行汇总。
纳入了来自9个国家的17项研究，共6039例患者。经直肠活检是确诊性活检最常用的活检方法。首次确诊性活检时升级的加权合并率为20%，95%置信区间为19%-21%。
接受主动监测的男性患者中，约20%在确诊性活检时风险升级。这可能会改变这些患者的治疗管理，凸显了确诊性活检的重要性。
