AUA 2018: Shared Decision Making for Treatment of Small Renal Masses: a Survey of Patients' Opinions Before and After Initial Counseling

San Francisco, CA ( In addition to surgery, percutaneous biopsy, thermal ablation and active surveillance are increasingly used in the management of patients with small renal masses (SRM). Few studies have investigated patient attitudes towards nonsurgical SRM treatments. The objective of this study was to evaluate patients’ opinions regarding renal mass biopsy, thermal ablation and surveillance for SRM management. 

A total of 100 consecutive patients with a SRM (<4cm) diagnosis were prospectively identified. Patients were given a 5-question survey before and after their initial office visit. Anxiety was assessed using a visual analog scale (1-10, least to most stressful time in life). Patients were excluded if they had a preexisting diagnosis of renal cell carcinoma (RCC), Bozniak 2F cystic mass, or SRM with macroscopic fat.

Of 100 patients, 31 were excluded for a preexisting diagnosis of RCC or benign findings. 69 patients completed the pre- and post-visit survey. Median age was 69, and 67% of patients were male. 18 patients were excluded from anxiety assessments due to previous counseling for a SRM. Prior to initial counseling, 45% of patients reported high anxiety (7-10), which decreased to 16% at the end of the encounter. Most patients (88%) answered yes when asked if

knowledge of cancer diagnosis would help make them make treatment decision and 94% of patients answered yes when asked whether they would consider renal mass biopsy. Following counseling, 43% of surveyed patients received renal mass biopsy. The most common reason

given for not obtaining a biopsy was that the physician did not believe it would change treatment recommendation. Prior to counseling, patients reported that they would consider treatment options including: 71% active surveillance (AS), 76% thermal ablation (TA), 78% partial nephrectomy (PN), and 39% radical nephrectomy (RN). When patients ranked (1-4) the most important factors to consider before treatment, the most common reasons were: risk of cancer spreading or coming back after treatment (75%) and risk of damage to the kidney (25%). 

Final diagnosis (biopsy or surgery) of SRM was RCC in 53, oncocytoma/AML 12, metastatic esophageal cancer and not biopsied in 34. Active surveillance/no treatment was the primary management for 48 patients.

In conclusion, a large majority of SRM patients are in favor of pre-treatment biopsy to improve decision making, although less than half of patients received biopsy after counseling. High anxiety is reported by half of SRM patients but decreases following physician visit.

Presented by: Anthony Bui, Bachelors of Science, University of Wisconsin School of Medicine and Public Health
Co-Author: Daniel D. Shapiro, Sara L. Best, Shane A. Wells, Lori Mankowski Gettle, Timothy J. Ziemlewicz, Meghan G. Lubner, J. Louis Hinshaw, Fred T. Lee, David F. Jarrard, Kyle A. Richards, Tracy M. Downs, Stephen Y. Nakada, E. Jason Abel, Madison, WI

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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