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Advances in Urology
Volume 2008, Article ID 705958, 6 pages
http://dx.doi.org/10.1155/2008/705958
Review Article

Surveillance as an Option for the Treatment of Small Renal Masses

Department of Urology, University Hospital Gasthuisberg, 3000 Leuven, Belgium

Received 22 April 2008; Accepted 13 July 2008

Academic Editor: J. Rubio

Copyright © 2008 S. Klaver et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. To review the natural history and biological potential of small renal masses in order to evaluate surveillance as a treatment option. Methods. Literature search of Medline and additional references from non-Medline-indexed publications concerning surveillance of small renal masses. Results. The natural history and biological potential of small renal masses can still not be unambiguously predicted at present. There seems to be no clear correlation between tumour size and presence of benign histology. The majority of small renal masses grow and the majority are cancer, but one cannot safely assume that a lack of growth on serial CT scans is the confirmation of absence of malignancy. Needle core biopsies could be used to help in decision making. They show a high accuracy for histopathological tumour type but are less accurate in evaluating Fuhrman grade. Conclusions. At present, surveillance of small renal masses should only be considered in elderly and/or infirm patients with competing health risks, in those with a limited life expectancy, and in those for whom minimal invasive treatment or surgery is not an option. In all other patients, active surveillance should only be considered in the context of a study protocol. Long-term, prospective studies are needed to provide a more accurate assessment of the natural history and metastastic potential of small renal masses.