Selecting Patients with Small Renal Masses for Active Surveillance

The incidentally discovered, clinically-localized, small renal mass (clinical stage T1aN0M0, ≤4cm) is the most commonly diagnosed entity in Renal Cell Carcinoma (RCC) – now accounting for at least 40% of newly diagnosed renal tumors. Given the above argument, Active Surveillance (AS) has emerged as a viable management strategy for SRM. This review will examine and discuss the existing literature regarding selection criteria for AS. AS of clinical T1a renal masses is emerging as a safe and effective management strategy in selected patients, yet appropriate patient selection and counseling remains an area of great interest. Long-term clinical outcomes are just beginning to be reported, thus much of the supporting evidence on AS and patient selection is based on retrospective data of heterogeneous quality. Nevertheless, there are certain conclusions that can be drawn, despite these current limitations. Appropriate selection of candidates should include a comprehensive evaluation of competing health risks, tumor characteristics, and patient preferences.