Reality check: The management of small renal masses in 2025 and beyond: Learning from the evolution of prostate cancer care.

Abstract

The early detection of small renal masses challenges us to distinguish between small renal masses appropriate for early treatment and those that can be safely managed conservatively. Clinicians caring for patients with small renal masses can draw numerous parallels to the evolution of the evaluation and treatment of patients diagnosed with low-risk prostate cancer. Reflexive treatment can have both serious side effects and long-term health implications that may outweigh the potential benefits-especially among those with limited life expectancy or significant comorbidities. In this article, we present current practices in the management of small renal masses that warrant a new perspective, and we propose a new Tumor-Organ Patient (TOP) conceptual framework to reduce overtreatment of small renal masses. The TOP model incorporates tumor biology, but also considers the patient's risk for loss of kidney function (the organ), as well as the patient's overall health (e.g. age, comorbidity, life expectancy). As we continue to refine our understanding of small renal masses, it is critical to learn the lessons of low-risk prostate cancer and to first "do no harm."