What are AUA guidelines for follow-up following surgery for renal cell carcinoma (RCC)?

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

As many as one third of patients with clinically localized disease may develop metastatic disease after nephrectomy, so they should be monitored carefully. In 2013, the AUA released a set of new guidelines addressing the follow-up and surveillance of clinically localized renal cancers treated with surgery or renal ablative procedures, biopsy-proven untreated clinically localized renal cancers followed on surveillance, and radiographically suspicious but biopsy-unproven renal neoplasms. [73]  Of the 27 statements in this guideline, the only one considered a grade A recommendation (standard of care) is that patients with a history of renal neoplasm who present with acute neurologic signs or symptoms should undergo prompt neurologic cross-sectional CT or MRI scanning of the head or spine, based on localization of signs and symptoms. [73]

Other recommendations and options outlined in the guideline include the following [73] :

  • Bone scan can be performed in patients with an elevated alkaline phosphatase level or clinical symptoms such as bone pain and/or radiographic findings suggestive of a bony neoplasm

  • For patients with a history of low-risk (pT1, N0, Mx) renal cell carcinoma that was managed surgically, chest x-rays should be performed annually for 3 years and then only as clinically indicated to assess for pulmonary metastases

  • For moderate- to high-risk patients managed surgically (pT2-4, N0, Nx or any N+), the panel recommends baseline abdominal imaging (CT or MRI) within 3 to 6 months following surgery, with continued imaging every 6 months for at least 3 years and annually thereafter to year 5

  • For patients on active surveillance, the panel recommends abdominal imaging (CT or MRI) within 6 months of active surveillance initiation to establish a growth rate, and then annually thereafter

  • Following ablation, patients should undergo cross-sectional CT or MRI, with and without IV contrast, at 3 and 6 months to assess treatment success, and annually thereafter for 5 years


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