Identifying Good Candidates for Active Surveillance of Kidney Cancer

With more abdominal imaging catching kidney cancer earlier on when tumors are smaller, there has been an increasing trend in the use of active surveillance for certain patients, said Yuzhi Wang, MD, research fellow, Vattikuti Urology Institute, Henry Ford Health.

However, the decision-making process is not simple, and there needs to be more education for both physicians and patients to make the best treatment decisions.

This transcript has been lightly edited for clarity.

Transcript

Why has the rate of active surveillance for kidney cancer been increasing and which patients are good candidates for active surveillance?

I think part of the reason is we are doing a lot more abdominal imaging, and we're catching a lot of kidney cancers earlier on. I think, in the past—when I was not aware of any of this—people would present with abdominal pain, feel a mass, they have blood in the urine. And then you do abdominal imaging, and you find a big mass on the kidney.

But nowadays, a lot of people get into car accidents, or they have abdominal pain, and you go to the ED [emergency department], and they give you a CT or some sort of abdominal imaging, and you find the mass on the kidney that you would have never known if you never like presented to the hospital. We've had a lot of smaller renal masses pop up—1 centimeter or 2 centimeter tumors—that could totally be appropriate for active surveillance. I think that's why we've gone towards more active surveillance for these patients, rather than aggressive treatment, because some tumors may not grow, and you can live your whole life and pass away not from the cancer, but with the cancer.

But there are also patients who will elect active surveillance and see their tumor grow in size, and that's when maybe we should start thinking about some sort of treatment. And I think urologists have just been more comfortable using active surveillance. There are multiple factors that play into it.

For the second part of your question, I think I touched on it a little before, but patients with smaller masses that are slow growing or not growing at all, patients who are older or have more comorbidities where the risk of going under treatment might actually outweigh the benefits, those are patients who would be a good candidate for active surveillance.

Your MUSIC-KIDNEY poster found nearly half the patients received discordant treatment. What can be done to improve this and help identify what the ideal treatment should be?

It's hard because, like I said, active surveillance vs treatment is also a nuanced decision. Just because a patient is appropriate for active surveillance doesn't necessarily mean that they want it or that it might be the best decision for them. I think we're talking a lot about active surveillance, or [the Michigan Urological Surgery and Improvement Collaborative], and we also host skill sessions.

I think through more education—with the physicians as well as education with patients—that can kind of help improve the discordant rates, but I don't think I'll ever be zero.