Reality check: The management of small renal masses in 2025 and beyond: Learning from the evolution of prostate
Simon John Christoph Soerensen1, Eugene Shkolyar2, Benjamin I Chung3
1Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA.
Abstract:
The early detection of small renal masses challenges us to distinguish between small renal masses appropriate for early treatment and those that can be safely managed conservatively. Clinicians caring for patients with small renal masses can draw numerous parallels to the evolution of the evaluation and treatment of patients diagnosed with low-risk prostate cancer. Reflexive treatment can have both serious side effects and long-term health implications that may outweigh the potential benefits-especially among those with limited life expectancy or significant comorbidities. In this article, we present current practices in the management of small renal masses that warrant a new perspective, and we propose a new Tumor-Organ Patient (TOP) conceptual framework to reduce overtreatment of small renal masses. The TOP model incorporates tumor biology, but also considers the patient's risk for loss of kidney function (the organ), as well as the patient's overall health (e.g. age, comorbidity, life expectancy). As we continue to refine our understanding of small renal masses, it is critical to learn the lessons of low-risk prostate cancer and to first "do no harm."
Insights
Early detection of small renal masses requires careful consideration. A new Tumor-Organ Patient (TOP) framework helps avoid overtreatment by assessing tumor biology, kidney function, and patient health.
Area of Science:
- Urology
- Oncology
- Nephrology
Background:
- Early detection of small renal masses (SRMs) presents a diagnostic challenge.
- Distinguishing SRMs requiring treatment from those manageable conservatively is crucial.
- Parallels exist between SRMs and low-risk prostate cancer management, highlighting risks of overtreatment.
Purpose of the Study:
- To present current practices in SRM management.
- To propose a new Tumor-Organ Patient (TOP) conceptual framework.
- To reduce overtreatment of small renal masses.
Main Methods:
- Review of current practices in small renal mass management.
- Development of the Tumor-Organ Patient (TOP) conceptual framework.
- Integration of tumor biology, organ function, and patient health factors.
Main Results:
- Current practices may lead to overtreatment of small renal masses.
- The TOP model offers a structured approach to decision-making.
- The framework considers tumor characteristics, kidney function risk, and patient comorbidities/life expectancy.
Conclusions:
- Overtreatment of small renal masses can lead to significant side effects and long-term health implications.
- The TOP model provides a novel perspective for personalized management of SRMs.
- Learning from prostate cancer management emphasizes the principle of 'first, do no harm'.
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