“The recommendations are based on the current evidence, but the evidence is overall relatively weak. So, I think there's a lot of room for improvement,” says Neal E. Rowe, MD, FRCSC.
In this video, Neal E. Rowe, MD, FRCSC, discusses potential future work building off the publication, “Diagnosis, management, and follow-up of the incidentally discovered adrenal mass: CUA Guideline Endorsed by the AUA,” as well as general unmet needs in the management of adrenal tumors. Rowe is an assistant professor at the University of Ottawa in Canada and a panel chair for the guideline by the Canadian Urological Association.
I would say we covered the whole scope of the field in the guideline, but it was evident that a lot of the background information wasn't of high quality. There's not a lot of randomized trials in this space. Although these lesions are common and there are a lot of publications out there, a lot of the literature is of low quality. The recommendations are based on the current evidence, but the evidence is overall relatively weak. So, I think there's a lot of room for improvement. When patients are worked up through the guideline, I would say one of the areas of interest is in patients with what was historically known as subclinical Cushing's syndrome that we now call mild cortisol secretion excess. In those patients, it's really not clear to us who should be treated with surgery and who shouldn't. So, it's kind of a case-by-case approach, and that's what we stated in our guideline. I'm very hopeful that future clinical trials may address that question.
I think in the big picture for the whole field, at the end of the day, there's a lot of indeterminant adrenal lesions, and despite our current laboratory and imaging investigations, we really can't clarify whether some of these lesions are benign or malignant. So, I think many patients are still having surgery that may not be required. I think the future is going to go in 2 directions. One is better laboratory investigations. There have been some big studies, looking at urine steroid metabolomics, looking at compounds in the urine that may be present in malignant tumors that aren't there for benign tumors. I think that field is exciting, but it's still in infancy in terms of making a guideline recommendation. The other is with better quality imaging. PET scan, with certain marked biomarkers, can look at the adrenal glands at the molecular level [and] perhaps help us identify which patients could benefit from surgery and which perhaps don't need surgery. They're looking at a variety of compounds that can be radio labeled for PET scanning. Again, this is not primetime, and probably not in infancy, and we'll see that down the road, but I anticipate that's something we're going to see in the next 10 to 15 years.
This transcription has been edited for clarity.