Active Surveillance for Small Renal Masses
With greater awareness of indolence underlying small renal masses (SRM ≤ 4 cm) and the morbidity of invasive
treatment, active surveillance for SRM patients is being increasingly utilized on an international level. This synopsis
summarizes the 2022 review and expert opinion recommendations provided to the International Consultation of
Urological Diseases (ICUD) by 10 urologists from high-volume active surveillance practices at international centers.
Topics reviewed include SRM biology and clinical behavior, current national and international guidelines for active
surveillance of SRM patients, active surveillance utilization patterns and barriers to implementation, outcomes and
limitations of the active surveillance literature, criteria for active surveillance patient selection, protocols for active
surveillance management including frequency/modality of imaging and the role of renal tumor biopsy, triggers
for delayed intervention during active surveillance including tumor factors and patient factors, and pathological
outcomes of delayed intervention. We conclude that despite limitations of the current literature, active surveillance
is a safe initial management strategy for many SRM patients. The slow growth and low metastatic potential of SRMs,
combined with no evidence to suggest oncologic compromise with delay to treatment, should provide confidence to
both patients and providers who are considering active surveillance. Future research for prioritization should include
characterization of long-term active surveillance outcomes including rates of metastasis and delayed intervention,
standardization of objective tumor progression criteria for triggering delayed intervention, and further delineation of
the role for active surveillance in young and healthy patients.
The Société International d'Urologie (SIU), which owns and publishes the Société International d'Urologie Journal (SIUJ), does not require authors of papers published in the journal to transfer copyright. Instead, we ask authors to grant an exclusive licence that allows us to publish the article in SIUJ (and any derivative or related products or publications) and that allows us to sub-license such rights and exploit all subsidiary rights.
Authors retain the right to use their own articles for their own non-commercial purposes without seeking explicit permission from SIU.
The SIUJ publication licence expressly defines “non-commercial” as “not primarily intended for or directed towards commercial advantage or monetary compensation.” Although no activity is completely disconnected from commercial activity, the following are generally considered to be non-commercial uses:
- Reproduction of a reasonable number (no more than 100) of print copies of the published paper for personal use (e.g., sharing with colleagues, including in grant applications).
- Posting a copy of the published version of the paper on the author’s own or their institution’s website. The article must be accompanied by this statement: ‘This article has been published in the SIUJ: [full citation; link]’.
- Inclusion of the paper in a course pack, with a maximum of 100 copies to be used in the author’s institution. The copies must include the following acknowledgement: ‘This article has been published in the SIUJ: [full citation; link].’
As the distinction between commercial and non-commercial is not always clear, authors are strongly advised to seek permission from SIU for any use that may be considered to have a commercial aspect.
We ask the corresponding author to read the terms of the licence and then to grant this exclusive licence on behalf of all authors by indicating agreement to the following statement:
The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence on a worldwide basis to the SIU and its licensees to permit this article (if accepted) to be published in the SIUJ and any other SIU products and publications and to exploit all subsidiary rights, as set out in our licence agreement.
Review and Decision
Most submissions will be reviewed by a senior editor within 2 weeks. Many manuscripts will be rejected at this point for a variety of reasons, including subject matter outside the scope of the SIUJ, flawed design, discredited or outdated methodology, poor organization or presentation, failure to conform to ethical requirements, and apparent plagiarism.The remaining manuscripts will be sent for peer review. The SIUJ uses a single-blind process: reviewers know the identity of the authors, but the authors are not told who has reviewed their manuscript, and SIUJ ensures that potentially identifying information is removed from comments sent to them. Reviewers are asked to make their recommendations within 10 days, after which a senior/specialist editor will consider their comments and recommend provisional acceptance dependent on satisfactory revision, acceptance without revision, or rejection. Authors should receive a final decision within 4 to 6 weeks of submission.