What are the AUA recommendations for active surveillance of renal cell carcinoma (RCC)?

Updated: May 21, 2019
  • Author: Kush Sachdeva, MD; Chief Editor: E Jason Abel, MD  more...
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Answer

AUA recommendations regarding active surveillance include the following [21] :

  • Active surveillance is an option for patients with small solid or Bosniak 3/4 complex cystic renal masses, especially those <2 cm (Conditional Recommendation; Evidence Level: Grade C).
  • For patients with a solid or Bosniak 3/4 complex cystic renal mass, active surveillance/expectant management should be prioritized when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment (Clinical Principle).
  • For patients with a solid or Bosniak 3/4 complex cystic renal mass in whom the risk/benefit analysis for treatment yields equivocal results and who prefer active surveillance, repeat imaging should be performed in 3-6 months to assess for interval growth; renal mass biopsy may be considered for additional risk stratification (Expert Opinion).
  • Active treatment is recommended for patients with a solid or Bosniak 3/4 complex cystic renal mass in whom the anticipated oncologic benefits of intervention outweigh the risks of treatment and competing risks of death; in this setting, active surveillance with potential for delayed intervention may be pursued only if the patient understands and is willing to accept the associated oncologic risk (Moderate Recommendation; Evidence Level: Grade C).

ESMO guidelines recommend active surveillance as an option in elderly patients with significant comorbidities or with a short life expectancy and tumors measuring 75</ref>


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