Version June 2024
| Active surveillance | |
| For patients with a solid kidney mass <2 cm, or those that are complex but predominately cystic, active surveillance with potential for delayed intervention is an option for initial management. | |
| Prioritize active surveillance when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of intervention. If asymptomatic, periodic clinical surveillance/imaging can be based on shared decision-making. | |
| When the risk/benefit analysis for treatment is equivocal and the patient prefers active surveillance, clinicians should repeat imaging in three to six months to assess for interval growth and may consider kidney mass biopsy for additional risk stratification. Repeat cross-sectional imaging should be obtained three to six months later. Periodic clinical/imaging surveillance can then be based on growth rate and shared decision-making with intervention recommended if substantial internal growth or if other clinical/imagining findings suggest that the risk/benefit analysis is no longer equivocal or favorable for continued active surveillance. | |
| When the oncologic benefits of intervention outweigh the risks of treatment and competing risks of death, clinicians should recommend intervention. In this setting, active surveillance may be pursued only if the patient is willing to accept the associated oncologic risk. Clinicians should encourage kidney mass biopsy for additional risk stratification. If the patient continues to prefer active surveillance, close clinical and cross-sectional imaging surveillance with periodic reassessment and counseling should be recommended. | |
| Factors favoring active surveillance | |
| Patient related | Tumor related |
| Older adults | Tumor size <3 cm |
| Life expectancy <5 years | Tumor growth <5 mm/year |
| High comorbidities | Noninfiltrative |
| Excessive perioperative risk | Low complexity |
| Frailty (poor functional status) | Favorable histology |
| Patient preference for active surveillance | Predominately cystic |
| Marginal kidney function | |
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