Active surveillance (AS) and primary intervention (PI) for small renal masses are associated with similar overall and cancer-specific survival, according to the findings of a prospective clinical trial.

Phillip M. Pierorazio, MD, of Johns Hopkins University in Baltimore, and colleagues enrolled 497 patients with small renal masses (4 cm or less in diameter). Of these, 223 (45%) chose AS and 274 (55%) chose PI. Of the AS patients, 21 (9%) switched to delayed intervention.

For the AS and PI groups, overall survival rates were 75% and 92%, respectively, and cancer-specific survival rates were 100% and 99%, respectively, differences that were not statistically significant, the investigators reported online ahead of print in European Urology.

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“The current report is among the first prospective analyses of patients electing for active surveillance of a small renal mass,” the researchers concluded. “Discussion of active surveillance should become part of the standard discussion for management of small renal masses.”

Compared with patients in the PI group, those in the AS group were older, had smaller tumors, and had worse Eastern Cooperative Oncology Group scores and total and cardiovascular comorbidities.