Active surveillance for small renal tumors: Have clinical concerns been addressed so far?
Article first published online: 6 NOV 2012
© 2012 The Japanese Urological Association
International Journal of Urology
Volume 20, Issue 4, pages 356–361, April 2013
How to Cite
Gontero, P., Joniau, S., Oderda, M., Ruutu, M., Van Poppel, H., Laguna, M. P., de la Rosette, J. and Kirkali, Z. (2013), Active surveillance for small renal tumors: Have clinical concerns been addressed so far?. International Journal of Urology, 20: 356–361. doi: 10.1111/j.1442-2042.2012.03227.x
- Issue published online: 1 APR 2013
- Article first published online: 6 NOV 2012
- Manuscript Accepted: 5 OCT 2012
- Manuscript Received: 11 JUN 2012
- active surveillance;
- kidney cancer;
- renal biopsy;
- small renal mass
The incidence of small renal masses is increasing, as a result of the wide adoption of imaging exams. Their management, however, is complicated, especially in patients with decreased life expectancy or comorbidities. Approximately 20% of small renal masses are benign and, even if malignant, just 10% show aggressive pathological features. Furthermore, competing cause mortality seems to exceed the cancer-specific mortality in patients aged over 70 years. The role of percutaneous tumor biopsy is still not well defined. All these observations raise the concern as to whether surgery might represent an overtreatment for some cases of small renal masses, calling into question the role of active surveillance. The aim of this review was to evaluate the current evidence pertaining to several hot questions that need to be addressed when contemplating active surveillance for small renal masses. The most relevant publications on this subject available in the literature were selected. Five representative series of active surveillance along with the main related variables were identified. Some relevant items surrounding the field of active surveillance were identified and submitted to an evidence-based discussion. According to the recent evidence, small renal masses under active surveillance tend to show an indolent course with a low probability of disease progression, the latter being triggered most of the time by a tendency to grow faster. Unfortunately, we are currently unable to predict those few cases with aggressive behavior. According to the current evidence, active surveillance is feasible and safe in elderly and comorbid patients.