Frances M. Alba, MD

Frances M. Alba, MD, discusses the benefits of active surveillance of small renal masses (SRM) as a treatment option. Dr. Alba begins by presenting data that most SRM have low or very low malignant potential. Despite this, SRM are removed routinely without preoperative pathologic diagnosis and Dr. Alba asserts this raises the question of significant overtreatment.

Dr. Alba then addresses metastasis, explaining that risk of metastases is exceedingly low for SRM. She describes a prediction calculator to support personalized-treatment selection and explains that regardless of treatment, the vast majority of patients will die of other causes. She emphasizes overall survival is influenced by patient risk factors.

Dr. Alba addresses quality-of-life issues for patients being treated with active surveillance, including the impact of illness uncertainty. She covers trends in active surveillance before outlining her recommendations, suggesting an initial period of six months to establish a trend. She advises asking patients about fears, concerns, and life events. She points out that active surveillance can be used to delay intervention in patients with competing medical or life issues and delayed intervention is safe.

Dr. Alba concludes by emphasizing that active surveillance is the ultimate nephron-sparing management modality and patients can be managed conservatively with serial imaging. Dr. Alba reminds practitioners that intervention for SRM imposes physical, emotional, mental, and financial burdens on patients and families, and that active surveillance can alleviate many of these concerns.