Medical Student, Research Year Student Department of Urology, Aarhus University Hospital, Denmark Aarhus C, Denmark
Background: Small Renal Masses (SRM) are often benign lesions or early-stage cancers with a very limited metastatic potential. The risk of overtreating SRM are especially of concern in elderly or comorbid patients, for whom the risks associated with active surveillance (AS) likely outweighs the risks and benefits of surgical management. Unfortunately, the knowledge concerning patient selection, long-term oncological outcomes and psychological side effects are still sparse.
Methods: A total of 149 patients in AS programs at three Danish urology centres were retrospectively identified and classified into four groups: AS (n=77), Delayed intervention (DI) (n=13), Deceased (n=23) and Discontinued (n=36). Patient characteristics and follow-up outcome were evaluated. The possible concerns associated with AS and living with a potential untreated cancer were investigated by an adjusted Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) survey.
Results: Respectively, mean age for the four groups was 70, 69, 74, and 78 years (p < 0.001), mean initial tumour size was 16, 20, 21, and 24 mm (p < 0.001), mean follow-up time was 26, 33, 25, and 22 months (p=0.31), and mean growth rate was 0.7, 3.5, 2.4, 2.2 mm/yr (p=0.09). The survey analysis included 87 AS patients and showed a significant higher FCRI-SF score for patients < 70 years compared to older patients (12.6 vs. 9.5 points, p=0.049). No different FCRI-SF score was observed for gender (p=0.97), Age-adjusted Charlson Comorbidity Index more or less than 5 points (p=0.97), initial biopsy or not (p-value 0.22) and follow-up time more or less than 18 months (p=0.35).
Conclusions: Age and initial tumor size were lower for AS and DI patients compared to Deceased and Discontinued patients. The FCRI-SF survey analysis showed no additional anxiety associated with AS in relation to fear of cancer progression, but patients younger than 70 years seems to be more psychological affected by an AS program.