Topic: Prevention and Screening

In part 2 of a 2-part series, Steven C. Campbell, MD, PhD, Professor of Surgery, Associate Director of Graduate Medical Education, Program Director and Vice Chair of Urology, and Eric A. Klein Chair for Urologic Oncology and Education at the Cleveland Clinic’s Glickman Urological and Kidney Institute, presents significant 2021 updates to the American Urological Association (AUA) guidelines on localized renal cancer, focusing on active surveillance (AS) and follow-up. Dr. Campbell, who served as Chair of the AUA Guidelines Panel for Management of Localized Kidney Cancer, begins by looking at the major revisions made to the AS guidelines, particularly with regard to specifications on which patients really should be considered for AS, the intensity of surveillance in different settings, and the role of renal mass biopsy. He then considers the revised guidance around follow-up after intervention. Dr. Campbell explains the general principles behind follow-up, highlighting the need to discuss implications of stage, grade, and histology including risks of recurrence and possible sequelae of treatment, as well as the importance of performing periodic imaging, lab studies, and medical histories in patients with treated malignant renal masses. He also covers what to do if surveillance suggests metastases or local recurrence. Dr. Campbell concludes by discussing risk-based protocols and follow-up guidelines based on risk categories and prior treatment.

In part 1 of a 2-part series, Steven C. Campbell, MD, PhD, Professor of Surgery, Associate Director of Graduate Medical Education, Program Director and Vice Chair of Urology, and Eric A. Klein Chair for Urologic Oncology and Education at the Cleveland Clinic’s Glickman Urological and Kidney Institute, presents significant 2021 updates to the American Urological Association (AUA) guidelines on localized renal cancer, focusing on evaluation and management. After an introduction by E. David Crawford, MD, Professor of Urology at the University of California, San Diego, and Editor-in-Chief of Grand Rounds in Urology, Dr. Campbell, who served as Chair of the AUA Guidelines Panel for Management of Localized Kidney Cancer, explains that the primary focus of the panel was clinically localized renal masses suspicious for cancer in adults, including solid enhancing renal tumors and Bosniak 3 and 4 complex cystic renal masses. He then summarizes what has changed since the last guideline update. For evaluation and diagnosis, he highlights that MRI with contrast can now be used even in patients with severe chronic kidney disease or with end-stage renal disease since the risk of nephrogenic fibrosis with 2nd generation gadolinium agents is extremely low. Dr. Campbell also notes that language has been changed around renal mass biopsy to emphasize a utility-based approach, and that there are expanded indications for genetic counseling since 4 to 6% of cases of renal cell carcinoma are now thought to be familial. He then moves on to look at the revised management guidelines, pointing out a new statement advising that patients with high-risk or locally advanced, fully resected renal cancers should be counseled about the risks/benefits of adjuvant therapy and encouraged to participate in adjuvant clinical trials, facilitated by medical oncology consultation when needed. Dr. Campbell concludes by looking at new guidance on thermal ablation indicating that renal mass biopsy should be performed prior to thermal ablation rather than at the time of thermal ablation.