Chapter

Renal Cell Carcinoma

Part of the series Current Clinical Urology pp 167-194

Date:

Active Surveillance of the Small Renal Mass

  • Marc C. SmaldoneAffiliated withDivision of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center
  • , Daniel CanterAffiliated withDivision of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center
  • , Alexander KutikovAffiliated withDivision of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center
  • , Robert G. UzzoAffiliated withDivision of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center Email author 

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Abstract

Increased abdominal imaging has led to the significant incidental detection of clinically localized renal tumors. While the gold standard remains surgical excision, no demonstrable improvement in cancer-specific mortality has been observed, implying that a proportion of small renal masses (SRMs) may be indolent tumors that do not require surgical intervention. As a result, active surveillance (AS) has emerged as an alternative management strategy in select elderly or comorbid patients with significant competing risks. Although the contemporary literature characterizing the natural history of untreated renal tumors is limited, recent data demonstrate that the majority of SRMs demonstrate slow growth kinetics with low rates of metastatic progression while under observation. Prospective trials are necessary to define entry and intervention criteria for contemporary AS protocols.