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Is there a place for surveillance in the management of small renal tumors?

Nature Clinical Practice Urology volume 3, pages 626–627 (2006)Cite this article

As a result of the steady improvement of imaging techniques, more and more small renal tumors are being detected incidentally. A considerable proportion of these tumors will never clinically significant, especially in elderly patients. In this article, we—as opponents of surveillance strategies—outline the arguments in favor of the surgical treatment of small renal tumors.

In order to decide whether a conservative surveillance strategy is an appropriate option in the management of these lesions, the question of their biological behavior must first be addressed. Recent reports describing slowed or arrested growth, and even spontaneous regressions, of small renal masses, without leading to death, support the use of surveillance strategies.1,2,3,4 Bosniak et al. were among the first to demonstrate a benefit for selected patients managed by 'watchful waiting'.3 These series are hampered, however, by the limited number of patients included, the advanced age of the patients, the retrospective study design, and follow-up periods that are too short to evaluate the true biological behavior of these lesions. No definitive conclusions can be drawn, therefore, until long-term follow-up data of patients managed by 'watchful waiting' are available. Future prospective studies should explore the relationship between tumor size and the potential of renal cell carcinoma (RCC) to grow and progress. In previous studies reporting RCC outcomes following surveillance, most patients eventually underwent surgery because of tumor enlargement or the fear of harboring cancer cells with an uncertain malignant potential.1 To date, however, the outcomes associated with discontinuation of surveillance as a result of metastatic spread have not been documented.

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Authors and Affiliations

  1. the Director of the Department of Urology at The University of Saarland, Homburg, Germany

    Frank Becker, Henrik Suttmann, Stefan Siemer & Michael Stöckle

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  1. Frank Becker
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  2. Henrik Suttmann
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  3. Stefan Siemer
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  4. Michael Stöckle
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Correspondence to Michael Stöckle.

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The authors declare no competing financial interests.

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Becker, F., Suttmann, H., Siemer, S. et al. Is there a place for surveillance in the management of small renal tumors?. Nat Rev Urol 3, 626–627 (2006). https://doi.org/10.1038/ncpuro0645

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