AUA Guideline: Full Kidney Removal Not Necessary for All Kidney Tumors

Early-stage renal masses should be treated with nephron-sparing approaches
when possible

LINTHICUM, Md., April 27 /PRNewswire-USNewswire/ -- Radical nephrectomy
(complete removal of the affected kidney) is not the best treatment for most
small kidney tumors because it puts patients at risk for chronic kidney
disease and cardiovascular disease. Nephron-sparing treatments, such as
partial nephrectomy, thermal ablation and active surveillance, minimize these
risks and are viable options for patients with early-stage kidney tumors,
according to a new clinical guideline issued by the American Urological
Association (AUA). The guideline was released on Tuesday, April 28, 2009
during the Association's Annual Scientific Meeting in Chicago.

This is the first time that the AUA has released official guidelines for the
management of patients with kidney cancer. This guideline is focused on the
management of patients with early-stage renal masses, which has become
controversial in the past few years. Guideline Panel Co-Chair Steven C.
Campbell, MD, PhD, will present the guideline to the media on April 28, 2009
at 12:30 p.m. in the AUA Press Suite, located at the Hyatt Regency McCormick
in Chicago.

Detection of clinical stage 1 (<7.0 cm) renal masses has increased in
frequency and is now a common clinical scenario for the practicing urologist.
Of these tumors, 20 percent are benign, 60 percent are indolent kidney cancer,
and only about 20 percent are potentially aggressive kidney cancer at the time
of diagnosis. Kidney cancer is the most lethal of the commonly diagnosed
urologic malignancies, but small, clinically confined tumors are very
heterogeneous, and most do not require radical nephrectomy.

"There are now several options available for the treatment of early stage
kidney cancer," said Steven Campbell, MD, PhD, co-chair of the panel that
developed the Guideline. "Radical nephrectomy is currently greatly
overutilized. Whenever possible, it is important to preserve renal function by
taking a nephron-sparing approach."

In preparing the guideline, the Panel assessed the efficacy of the following
major treatment modalities:

Partial Nephrectomy: Surgical excision by partial nephrectomy is a reference
standard for the management of clinical T1 renal masses, whether for
imperative or elective indications, given the importance of preservation of
renal function and avoidance of chronic kidney disease. In general, open
partial nephrectomy is preferred for complex cases such as hilar tumor
location and solitary kidney.

Thermal Ablation: Thermal ablation (cryoablation or radiofrequency ablation),
performed either percutaneously or laparoscopically, is an appealing treatment
option for the patient at high surgical risk who wants active treatment and
accepts the need for long-term radiographic surveillance. Counseling about
thermal ablation should include a balanced discussion of the increased risk of
local recurrence when compared to surgical excision, the potential need for
reintervention, the potential for difficult surgical salvage if tumor
progression is found and the substantial limitations of the current thermal
ablation literature.

Active Surveillance: Active surveillance is a reasonable option for the
management of localized renal masses that should be a primary consideration
for patients with decreased life expectancy or extensive comorbidities that
would increase the risks of intervention. However, more aggressive or larger
tumors (>3 to 4 cm) should be managed in a proactive manner, if possible.

Radical Nephrectomy: Radical nephrectomy is still occasionally required. A
laparoscopic approach should be considered because it is associated with a
more rapid recovery profile.

The Guideline Panel also addressed the following novel treatment modalities:
high-intensity focused ultrasound, radiosurgery, microwave thermotherapy;
laser interstitial thermal therapy; and pulsed cavitational ultrasound.

The "Guideline for Management of the Clinical Stage 1 Renal Mass" will be
published in The Journal of Urology(R) later this year. A press conference on
the Guideline will be held on April 28, 2009 at 12:30 p.m. at the Hyatt
Regency McCormick Place during the AUA Annual Meeting in Chicago, IL. For more
information on covering the press conference or to schedule an interview,
please contact Lacey Dean at LDean@AUAnet.org.

Panel Members included: Steven C. Campbell, MD, PhD, Co-Chair; Arie
Belldegrun, MD; Michael L. Blute, MD; George Kuoche Chow, MD; Ithaar H.
Derweesh, MD; Jihad H. Kaouk, MD; Raymond J. Leveille, MD; Surena F. Matin,
MD; Paul Russo, MD; Robert Guy Uzzo, MD; and the late Andrew C. Novick, MD.

About the American Urological Association: Founded in 1902 and headquartered
near Baltimore, Maryland, the American Urological Association is the
pre-eminent professional organization for urologists, with more than 16,000
members throughout the world. An educational nonprofit organization, the AUA
pursues its mission of fostering the highest standards of urologic care by
carrying out a wide variety of programs for members and their patients.
MEDIA CONTACTS:
AUA Media Relations: 410-689-3932
Lacey Dean: 410-689-4054
ldean@AUAnet.org

SOURCE American Urological Association

American Urological Association Media Relations, +1-410-689-3932; Lacey Dean
of the American Urological Association, +1-410-689-4054, ldean@AUAnet.org