The percentage of positive biopsy cores in predicting biochemical recurrence and adverse pathology in prostate cancer patients after radical prostatectomy: a systematic review and meta-analysis

Background: Biochemical recurrence (BCR) occurs in more than one-third of prostate cancer (PCa) patients 10 years after radical prostatectomy. The percentage of positive biopsy cores (PPBC) obtained from prostate needle biopsy is suggested as one of the predictors of BCR. We aim to investigate the role of PPBC in predicting BCR and adverse pathology in PCa patients after RP. Methods: A systematic search was conducted based on PRISMA guidelines from Pubmed, Scopus, and Cochrane Library databases up to July 2022. We screened studies that met our inclusion criteria and NOS (Newcastle-Ottawa Scale) was utilized as the quality assessment tool. The primary outcome was BCR measured as Hazard Ratios (HRs). The secondary outcome was adverse pathology, including positive surgical margin (PSM), Extra-prostatic disease (EPD), and seminal vesicle invasion (SVI). Review Manager((R))5.4 was used as the statistical analysis tool. Results: A total of 5971 patients were included from eleven eligible studies with overall good quality scores. Eleven studies were included in the qualitative synthesis and five of them were analyzed in the meta-analysis. The pooled analysis demonstrated that higher PPBC has a 2.77 times risk of BCR (OR 2.77 (95% CI: 1.97, 3.9; p<0.00001) after RP. Similarly, it has significant results in SVI (OR 2.61 (95% CI: 1.19, 5.73; p=0.02). However, there were insignificant results in terms of EPD (p=0.17) and PSM (p=0.33). Conclusion: This systematic review and meta-analysis (SRMA) indicate that a high PPBC is strongly correlated with a greater risk of BCR and SVI, but not EPD and PSM in patients following RP.