EAU 2013 - Programme Book - YouMed

Sunday
Sunday, 17 March - EAU Programme
168 Programme Book
Thematic Session 6
11.00 - 12.00 Small renal masses: To treat or not to treat?
eURO Auditorium - Level S2
Chair: P.F.A. Mulders, Nijmegen (NL)
11.00 - 11.15 State-of-the-art lecture Needle biopsy of renal masses: When and how
M. Kuczyk, Hanover (DE)
Aims and objectives
During recent years a revival of the biopsy of renal masses can be observed. On one hand this is due to
the increasing frequency of incidentally detected small renal masses that are, in part, treated by ablative
techniques. However, the histological differentiation of small renal masses is benign in up to 30% of cases.
The individual patient should not be subjected to a treatment that is associated with a distinct complication
rate until malignancy has been proven. Today, an organ-preserving strategy is the standard of care during
the treatment of small renal masses. In case of an unfavourable localisation of renal tumours that might
make organ-preservation difficult, biopsy can be recommended to prove a malignant differentiation upfront
surgery.
11.15 - 11.20 Case presentation: A patient with an incidentaloma of the kidney
P.F.A. Mulders, Nijmegen (NL)
11.20 - 11.50 Debate How to survive a small renal mass
11.20 - 11.35 Pro Observation
M. Jewett, Toronto (CA)
Aims and objectives
Small Renal Mass (SRM) is the most common presentation for RCC but not all SRMs are malignant. Needle core
biopsy is an accurate and safe diagnostic method that is underutilised. The standard for treatment is partial
nephrectomy with ablation in selected cases. Most RCC SRMs grow slowly so that initial active surveillance
(AS) using serial imaging with delayed treatment for progression is an option, particularly in the older and
infirm. Markers of progression are poorly understood and currently we depend on rapid growth as the main
trigger for treatment. We are in the early phase of personalising AS strategies by tumour characteristics
including histology and host comorbidity status. Urologists should have a current understanding of this
new clinical entity SRM to better manage new RCC patients with a disease that is increasing due to image
detection of incidental lesions. Most are RCC which is the most lethal of GU malignancies and can not be
cured if metastatic. This concern is probably leading to unnecessary treatment of many SRM that could be
managed by AS.
11.35 - 11.50 Con Minimally invasive partial nephrectomy
I.S. Gill, Los Angeles (US)
Aims and objectives
My lecture will present the data and the rationale for surgical treatment of small renal masses in the healthy
patient with projected longevity. Pros and cons of active surveillance will be presented. The inadequacy of
imaging in diagnosing cancer, and the emerging role of needle biopsy will be discussed.