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    Renal cancer follow-up: Find the happy medium

    Adele M. Caruso, MSN, CRNPAdele M. Caruso, MSN, CRNP

    Urology Times Blogger Profile

    Ms. Caruso is a nurse practitioner at the University of Pennsylvania Health System, Philadelphia.

     

    What is the right amount when it comes to patient follow-up for treated renal cancers? What are advanced practice providers and physicians really doing around the country? Is there consistency? What are the guidelines? In this blog post, I will provide an overview of current practices in renal cancer follow-up and also look at related health insurance coverage and cancer survivorship issues.

    Also from Adele Caruso - PSA screening: Be a resource for your patients, providers

    Post-treatment renal cancer follow-up. What is the right amount? In recent years, we have seen a considerable stage shift in renal cell carcinoma. Smaller treated masses can have a more protracted or indolent history. Additionally, with renal-sparing surgery, there is less worry of renal deterioration and a lower need for constant short-term monitoring. Also, during this time we have gained further information on the long-term outcomes of larger masses that have been successfully treated. Late recurrences in multiple sites can be more common than previously thought.

    Not too much. Standard schedules and techniques for monitoring have been rethought as our concerns for excessive radiation exposure and contrast media toxicity have grown. Additionally, the natural history of small renal masses allows for a thorough yet longer interval period between evaluations.

    Not too little. As we become comfortable with longer periods between evaluation and less intensive evaluation, it is important not to let this lapse into a program more similar to watchful waiting. This is especially true since patients are often non-compliant with obtaining follow-up studies. It would be inappropriate for large time periods to lapse between studies.

    Just right. In 2013 , the AUA created evidence-based guidelines for follow-up of treated renal cancers with surgery or renal ablative procedures. Additionally, these guidelines address surveillance of clinically localized renal cancers—both biopsy-proven untreated and biopsy-unproven renal masses treated with renal ablative procedures or surveillance. The guideline statements are based on the best available evidence and expert opinion.

    Next: The AUA's stance

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