title: Predictive Factors for Reclassification and Relapse in Prostate Cancer Eligible for Active Surveillance: A Systematic Review and Meta-analysis.
abstract: To systematically evaluate the evidence on the predictors of the upgrading and biochemical recurrence of prostate cancer (PC) in those patients with low-risk disease assigned to active surveillance (AS).
  
  
  
  An electronic search of the PubMed, SCOPUS, Web of Science, CINAHL, Cochrane Library, Google Scholar, and Embase databases was performed for all reports that included detailed results of multivariate analyses of the predictors of PC reclassification and biochemical relapse during AS. Cumulative analyses of available hazard ratios (HRs) and their corresponding 95% confidence intervals were conducted using the RevMan 5.3 software to assess the potential predictors of PC upgrading and recurrence. Both random-effect model meta-analysis and Hartung-Knapp-Sidik-Jonkman meta-analysis method were applied to obtain the pooled HR for each covariate.
  
  
  
  In the 32 articles analyzed, encompassing about 24,236 patients with early-stage PC, the 3 clinicopathological variables significantly associated with histological progression during AS were: prostate-specific antigen-density (HR 2.46; P = .0001); 2 positive cores (HR 1.54; P = .006); and race (HR 2; P = .04). Age, prostate-specific antigen levels, and suspicion on magnetic resonance imaging were not significantly associated with increased risk of progression of PC.
  
  
  
  We identified 3 strong predictors for the upgrading of PC during AS. These should be systematically evaluated to enable patients with low-risk disease to be treated with AS.
authors.affiliation: Oncology Division, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, BG, Italy. Electronic address: faupe@libero.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Petrelli
authors.affiliation: Urology Division, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, BG, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Vavassori
authors.affiliation: Oncology Division, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, BG, Italy.
authors.forename: Mary
authors.initials: M
authors.lastname: Cabiddu
authors.affiliation: Oncology Division, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, BG, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Coinu
authors.affiliation: Oncology Division, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, BG, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Ghilardi
authors.affiliation: Oncology Division, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, BG, Italy.
authors.forename: Karen
authors.initials: K
authors.lastname: Borgonovo
authors.affiliation: Oncology Division, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, BG, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Lonati
authors.affiliation: Oncology Division, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, BG, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Barni
mesh_terms: D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000145:classification* / Q000628:therapy*; D057832:Watchful Waiting
chemical_list: D017430:Prostate-Specific Antigen