Active Surveillance for Small Renal Masses
Abstract
With greater awareness of indolence underlying small renal masses (SRM ≤ 4 cm) and the morbidity of invasive
treatment, active surveillance for SRM patients is being increasingly utilized on an international level. This synopsis
summarizes the 2022 review and expert opinion recommendations provided to the International Consultation of
Urological Diseases (ICUD) by 10 urologists from high-volume active surveillance practices at international centers.
Topics reviewed include SRM biology and clinical behavior, current national and international guidelines for active
surveillance of SRM patients, active surveillance utilization patterns and barriers to implementation, outcomes and
limitations of the active surveillance literature, criteria for active surveillance patient selection, protocols for active
surveillance management including frequency/modality of imaging and the role of renal tumor biopsy, triggers
for delayed intervention during active surveillance including tumor factors and patient factors, and pathological
outcomes of delayed intervention. We conclude that despite limitations of the current literature, active surveillance
is a safe initial management strategy for many SRM patients. The slow growth and low metastatic potential of SRMs,
combined with no evidence to suggest oncologic compromise with delay to treatment, should provide confidence to
both patients and providers who are considering active surveillance. Future research for prioritization should include
characterization of long-term active surveillance outcomes including rates of metastasis and delayed intervention,
standardization of objective tumor progression criteria for triggering delayed intervention, and further delineation of
the role for active surveillance in young and healthy patients.
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