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cua guidelines: SRMs

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coMMentaRy

Canadian guidelines for SRMs: How Canadian are they?

Peter Black, MD, FRCSC

Department of Urologic Sciences, University of British Columbia, Vancouver, BC

See related article on page 160. new guidelines compare to other international guidelines,
how they differ from the prior KCRNC consensus statement,
and what makes them specifically Canadian. The answer to
Cite as: Can Urol Assoc J 2015;9(5-6):163,213. http://dx.doi.org/10.5489/cuaj.3040 all these questions is: not much.
Published online June 15, 2015. Specific Canadian content to the literature on the man-
agement of SRMs relates primarily to the utility of renal mass
6-8
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mall renal masses (SRM) are encountered by most urol- biopsy and the adoption of active surveillance, both of
ogists as part of their routine clinical practice, which which we as a Canadian community of urologists would
Smakes best practice statements or guidelines like those generally promote. However, neither of these components
published in this month’s CUAJ important in standardizing is emphasized particularly strongly in the current guidelines,
1
care. While it is good for patients to have options, the man- reflecting a degree of uncertainty in their widespread adop-
agement of SRMs has started to resemble that of localized tion. With respect to these two issues, these guidelines do
prostate cancer – each patient and the treating physician not read much differently than the AUA guidelines from
have many potentially difficult choices to make, and there 2010, which also recognize an increased role for biopsy
is an underlying concern for over-treatment. and allow for active surveillance in older patients and those
The European Association of Urology (EAU) and the with significant medical comorbidities. The EAU and NCCN
4
National Comprehensive Cancer Network (NCCN) have guidelines do not really entertain the notion of SRM biopsy
recently updated their kidney cancer guidelines includ - to decide on surgical intervention versus surveillance, but
ing the management of SRMs. The American Urological instead limit its scope to patients with metastatic disease,
2,3
Association (AUA) published guidelines specifically on those on surveillance, or those undergoing ablation. The
SRMs in 2009 and validated these in 2010. Furthermore, NCCN guidelines are more restrictive than these Canadian
4
the Kidney Cancer Research Network of Canada (KCRNC), guidelines with respect to use of ablative procedures, and
which includes many of the same contributors who drew up reserve these for patients who are explicitly not candidates
these SRM guidelines, has developed best practice guide- for surgery. However, this represents a deviation of the
lines in the past. The question therefore arises how these Continued on page 213
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