Small renal mass and low-risk prostate cancer: any more for active surveillance?

摘要

In Europe in 2010 there were approximately 88 400 new cases of renal cell carcinoma (RCC) and 39 300 RCC-related deaths. Within this overall number, the incidence of small renal masses (SRMs) has shown the largest relative increase, with a 3.7% per year rise in incidence [1]. The incidental detection rate of SRMs has risen from 7% to 13% in the 1970 s to 48% to 66% today, and in keeping with this stage migration, 38% of tumours excised are now classified SRMs [2]. The median age of diagnosis of RCC is 65 yr, and most SRMs are diagnosed in an elderly population. With the life expectancy of central Europe continuing to rise, it is estimated there will be 173 million people >65 yr of age in Europe in 2025. Combine this with the liberal use of abdominal imaging, said to identify a renal lesion in 13-27% of cases [3], and clearly we will be faced with a huge number of newly diagnosed SRMs in an ageing comorbid population.