Around half of all cases of renal cell carcinoma (RCC) are incidentally diagnosed on imaging as small renal masses, clinical stage T1a and smaller than 4 cm. Around 30% of small renal masses are found to be benign. The management of small renal masses is under debate, including whether a biopsy should be performed for diagnosis, and how these masses should be treated (active surveillance, ablation, partial/radical nephrectomy).

This study looked at patient anxiety and psychological distress at various disease time points in patients with small renal masses and younger than 70 years. Psychological distress was compared for those patients who had active surveillance to those treated with surgery or ablation.

Of a total of 477 patients, 217 underwent surveillance, while 260 underwent surgery/ablation. Patients on surveillance were, on average older but with smaller mean tumour size. Patients on surveillance with a biopsy-proven malignant tumour had a worse psychological distress score compared to patients treated with surgery/ablation after biopsy, and at last follow-up.

In conclusion, despite the limitations of this study (retrospective nature with clear selection bias), this is the first study to compare psychological distress in patients with small renal masses undergoing surveillance or surgery/ablation. Patients with a small renal mass undergoing surveillance have a similar psychological distress score as those treated with surgery. However, patients with a biopsy-proven malignant tumour who were on surveillance had worse psychological distress following the biopsy and at last follow-up. These patients should be offered supportive psychological care, especially if they have a biopsy-proven malignant tumour.

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