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Update on active surveillance for clinical T1 renal tumors
Gregory A Joice1, Phillip M Pierorazio, Mohamad E Allaf
1Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Purpose Of Review:
The purpose is to discuss current data on the utilization and outcomes of active surveillance for T1a renal masses. Specifically, to address which patients are optimal for active surveillance and how their outcomes differ from those undergoing immediate treatment.
Recent Findings:
Although nephron sparing surgery is the standard of care for small renal masses (SRMs), active surveillance is becoming a more popular intervention given the results of prospective studies revealing active surveillance to be safe and have excellent cancer-specific survival with intermediate follow-up. Older and sicker patients have competing risk of death from other causes when diagnosed with a SRM.
Summary:
Active surveillance is becoming a more popular treatment modality for SRMs given the increasing number of incidental diagnoses and better understanding of their often indolent course. Active surveillance with delayed intervention is a well-tolerated treatment modality and appears to have the most benefit for those patients that are older with more comorbidities.
Insights
Active surveillance for T1a renal masses is safe and effective, particularly for older patients with comorbidities. This approach offers excellent cancer-specific survival, making it a viable alternative to immediate treatment for select individuals.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Small renal masses (SRMs) are increasingly diagnosed incidentally.
- Nephron sparing surgery is the standard of care for SRMs.
- Active surveillance is gaining popularity for SRMs due to their often indolent nature.
Purpose of the Study:
- To review current data on active surveillance for T1a renal masses.
- To identify optimal candidates for active surveillance.
- To compare outcomes of active surveillance versus immediate treatment.
Main Methods:
- Review of prospective studies on active surveillance for T1a renal masses.
- Analysis of patient characteristics and outcomes.
- Comparison of survival rates between surveillance and treatment groups.
Main Results:
- Active surveillance is a safe intervention for T1a renal masses.
- Excellent cancer-specific survival is observed with active surveillance.
- Older patients with comorbidities benefit most from active surveillance due to competing risks of death.
Conclusions:
- Active surveillance is a well-tolerated and effective management option for select patients with T1a renal masses.
- Delayed intervention via active surveillance offers significant oncologic benefit.
- Patient selection is crucial for optimizing outcomes in active surveillance for SRMs.
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