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 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 (PSA)-density (HR 2.46; p = 0.0001); 2 positive cores (HR 1.54; p = 0.006); and race (HR 2; p = 0.04). Age, PSA levels and suspicion on MRI 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 in this way.