AUA 2018: Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – PRO

San Francisco, CA (UroToday.com) Jaime Landman, MD gave a presentation advocating for the use of thermal ablation for small renal masses (SRM). SRM is a CT driven dilemma. Over the years, CT usage has risen exponentially. The usage of CT scans has jumped from 1995 to 2016 by 30-fold. Approximately 30% of renal masses are less than 3 cm, with the highest incidence among people aged 75-85.

AUA 2018: Survival Following Upfront Cytroreductive Nephrectomy vs Targeted Therapy for Metastatic Renal Cell Carcinoma

San Francisco, CA (UroToday.com)  Currently, the optimal treatment path for patients with metastatic renal cell carcinoma remains to be established. Bimal Bhindi, MD and colleagues had a goal to try to identify the best treatment for a subset of patients.

AUA 2018: Conditional Survival and Landmark Analysis for Patients with Small Renal Masses Undergoing Active Surveillance at a Tertiary Care Center

San Francisco, CA (UroToday.com)  Conditional survival can provide guidance for patients once they have survived a period of time after diagnosis of their disease. In this study, the authors determined conditional survival for patients with small renal masses (SRM) undergoing active surveillance (AS). 

AUA 2018: Debate: 10 years of Big Data Have Changed Renal Cell Carcinoma Management

San Francisco, CA USA (UroToday.com) In this lively last debate, the focus was on whether big data has changed RCC management. Dr. Shuch focused recent findings that have affected our understanding of renal cell carcinoma (RCC). He emphasized that “Big Data” is not large population-level databases, but rather next-generation sequencing; data on the order megabases and kilobases. There have many articles using different datasets, both public and institutional, that have explored RCC genomic profiles in an effort to answer bigger questions.

The three main uses for big data in RCC have been molecular subtyping, prognostication, and therapeutic targeting. 

AUA 2018: Debate - Adjuvant Therapy for High Risk RCC Should Be Used

San Francisco, CA (UroToday.com) In this third debate, two medical oncologists debated the utility and appropriateness of adjuvant therapy for high-risk localized renal cell carcinoma (RCC) in the current era.  PRO: Daniel George, MD started by advocating for sunitinib in the adjuvant setting – based on recent FDA approval for the drug in this setting. 

He started by focusing on S-TRAC, the only randomized control trial to demonstrate a benefit to adjuvant therapy. In the updated S-TRAC data, in a central independent review, there was a disease-free survival benefit to use of adjuvant sunitinib over placebo in high-risk patients (HR 0.76, p = 0.03). This translated to a 5-year absolute benefit of approximately 8.0%. He then went on to make an excellent point that this exceeds the absolute benefit of many adjuvant therapies in other malignancies – all of which are standard of care (ie oxaliplatin for colon cancer, docetaxel for breast cancer, Herceptin for breast cancer, ipilimumab for melanoma – all <8% 5-year absolute risk reduction).

AUA 2018: Debate - Tumor Enucleation for Sporadic T1 RCC is Oncologically Sound

San Francisco, CA (UroToday.com) In this second debate, the question was whether tumor enucleation for sporadic T1 RCC was appropriate. The focus was primarily supposed to be on oncologic outcomes.Tumor enucleation was “created” for patients with a genetic predisposition for bilateral, recurrent renal masses – in an effort to spare renal parenchyma and a high likelihood for repeated procedures.

AUA 2018: Debate - Active Surveillance for Large Renal Masses is Appropriate

San Francisco, CA (UroToday.com) In this first debate in the kidney cancer section, the focus was on the role of active surveillance for large renal masses (>= 7 cm). While AS for small renal masses has become more established, there is a question about its utility in larger renal masses. Below are the highlights of the Pro and Con position provided by two leaders in the field.
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