AUA updates guideline on renal masses and localized renal cancer

Jason M. Broderick

The American Urological Association (AUA) has officially amended its clinical guideline on Renal Masses and Localized Renal Cancer.1

"Renal cancer is one of the ten most common cancers in both men and women," Steven C. Campbell, MD, PhD, chair of the AUA Renal Mass Guideline Panel, stated in a press release. "We believe this revised guideline will provide a useful, evidence-based clinical reference for the medical and surgical management of renal masses and localized renal cancer."

The guideline was initially published in 2013 and was last amended in 2017. The following sections summarize the updates made to the guideline.

Genetic Counseling for patients

Patients aged ≤46 years with renal malignancy and patients with multifocal or bilateral renal masses should definitively be recommended for genetic counseling. Three other situations in which the guidelines stipulate that clinicians should recommend genetic counseling are:

  • A familial renal neoplastic syndrome is indicated by an individual’s personal or family history
  • The individual has a first- or second-degree relative with a known clinical or genetic diagnosis of a familial renal neoplastic syndrome or with a history of renal malignancy (even in the absence of a specific observation of kidney cancer)
  • Histologic findings shown by the patient's pathology are indicative of a renal neoplastic syndrome.

Renal Mass Biopsy (RMB)

  • A prior statement on RMB is now evidence based. The statement recommends patients received counseling on the rationale for RMB, positive and negative predictive values, risks to the patient, and non-diagnostic rates of RMB.
  • RMB should be considered by clinicians when there is suspicion that a mass is metastatic, hematologic, infectious, or inflammatory, as well as for those individuals harboring a solid renal mass who choose RMB. As opposed to fine need aspiration, the preferred process is performing multiple core biopsies.

Radical Nephrectomy

When tumor size, RMB, and/or imaging indicated increased oncologic potential, radial nephrectomy should be considered for patients with a solid or Bosniak 3/4 complex cystic renal mass.

Thermal Ablation

  • When a patient has a cT1a solid renal mass that is less than 3 cm, thermal ablation should be considered as an alternate treatment strategy.
  • When possible, a percutaneous technique is recommended over a surgical approach to minimize morbidity in patients choosing to receive thermal ablation.

Updates on active surveillance

  • Among patients with a solid or Bosniak 3/4 complex cystic renal mass that is solid or has solid components, RMB should be considered for additional stratification of oncologic risk when the treatment risk/benefit assessment is ambiguous and the patient would prefer active surveillance.
  • When patients have a solid or Bosniak 3/4 complex cystic renal mass and a positive benefit/risk ratio regarding the expected benefit of oncologic intervention, the intervention should be recommended.
  • In circumstances when active surveillance is a feasible option, it should only be implemented if the patient has a full understanding and acceptance of the oncologic risks of pursuing this strategy.

The final update the AUA made is that there is now an “other considerations” section in the guideline.

For additional information on the update, the full guideline can be accessed online.

Reference

1. American Urological Association Announces Updates to Clinical Guidance for Renal Mass and Localized Renal Cancer. Published online May 26, 2021. Accessed June 1, 2021. https://prn.to/34BsnfJ.