| Active surveillance | |
| For patients with renal masses suspicious for cancer, especially those <2 cm, active surveillance is an option for initial management. | |
| Prioritize active surveillance/expectant management when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment. | |
| When the risk/benefit analysis for treatment is equivocal and the patient prefers active surveillance, clinicians should repeat imaging in three to six months to assess for interval growth and may consider renal mass biopsy for additional risk stratification. | |
| When the oncologic benefits of intervention outweigh the risks of treatment and competing risks of death, clinicians should recommend active treatment. In this setting, active surveillance may be pursued only if the patient understands and is willing to accept the associated oncologic risk. | |
| Factors favoring active surveillance/expectant management | |
| Patient related | Tumor related |
| Older age | Tumor size <3 cm |
| Life expectancy <5 years | Tumor growth <5 mm/year |
| High comorbidities | Noninfiltrative |
| Excessive perioperative risk | Low complexity |
| Frailty (poor functional status) | Favorable histology |
| Patient preference for active surveillance | |
| Marginal renal function | |
