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Active Surveillance of Renal Tumors

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Diagnosis and Surgical Management of Renal Tumors

Abstract

Asymptomatic solid small renal masses are an increasingly common clinical entity. While most small renal masses are malignant, many have limited metastatic potential as evidenced by a significant proportion of benign and indolent pathology, slow growth rates under surveillance, and very low rates of metastatic progression. Active surveillance has emerged as a management option for well-selected patients. Prospective cohorts with defined inclusion criteria for active surveillance and triggers for delayed intervention demonstrate that small renal masses can be safely managed on active surveillance with comparable survival outcomes, renal function, and quality of life compared to patients undergoing primary intervention. While outcomes continue to mature, the growing data is promising not only for elderly and comorbid patients but also potentially a more broadly selected population with small renal masses. Expanding inclusion criteria for active surveillance will depend on better initial risk stratification, based on tumor and patient characteristics, emerging diagnostic modalities, and shared decision-making with patients showing signs of progression. There is no consensus on optimal growth rate thresholds or other triggers for intervention, but renal mass biopsy and novel imaging modalities may be increasingly used in this setting. Active surveillance is currently underutilized on a population-level, and long-term follow-up will likely solidify its role in the management of renal tumors.

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Abbreviations

CT:

Computed tomography

DISSRM:

Delayed intervention and surveillance for small renal masses

ECOG:

Eastern Cooperative Oncology Group performance status

MRI:

Magnetic resonance imaging

SRM:

Small renal mass

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Authors and Affiliations

  1. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Hiten D. Patel & Phillip M. Pierorazio

Authors
  1. Hiten D. Patel
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  2. Phillip M. Pierorazio
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Correspondence to Hiten D. Patel .

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Editors and Affiliations

  1. The James Buchanan Brady Urological, Institute and Department of Urology, Johns Hopkins University School of Medic, Baltimore, MD, USA

    Michael A. Gorin

  2. The James Buchanan Brady Urological, Institute and Department of Urology, Johns Hopkins University School of Medic, Baltimore, MD, USA

    Mohamad E. Allaf

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Patel, H.D., Pierorazio, P.M. (2019). Active Surveillance of Renal Tumors. In: Gorin, M., Allaf, M. (eds) Diagnosis and Surgical Management of Renal Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-92309-3_7

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  • DOI: https://doi.org/10.1007/978-3-319-92309-3_7

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