How Does Treatment Uncertainty Factor into Decisions to Place Patients on Active Surveillance for Kidney Cancer?

There are various management options for localized kidney cancer, including active surveillance, thermal ablation, partial nephrectomy, and radical nephrectomy. Choosing the optimal management requires consideration of oncologic outcomes, overall survival, and potential harms associated with each option. Oncologic outcomes and overall survival are determined by tumor and patient characteristics, respectively, and represent relatively objective metrics. The comparative harms of different management approaches are less predictable and result in treatment-related uncertainty. Active surveillance offers less uncertainty for many patients with localized kidney cancer: operative risks are completely forgone, oncologic outcomes are excellent, anxiety and illness uncertainty are well managed, and delayed intervention can be safely pursued. Patient summary: We reviewed the causes of treatment-related uncertainty associated with management options for localized kidney cancer. We discuss how active surveillance offers a certain degree of certainty according to the available literature. This could influence the decision to place patients on active surveillance.