William C. Huang, MD, Guest Editor

Samir S. Taneja, MD, Guest Editor

The story of renal cancer is progressively becoming similar to the story of another urologic malignancy––prostate cancer. Although we do not screen for kidney cancer, the liberal use of imaging has contributed to a steady increase in the incidence of renal cancer, with a subsequent downward size and stage migration. With an increased understanding of the natural history of the disease as well as the improvements in imaging and diagnostic techniques, there has been a realization that every newly diagnosed tumor does not necessarily require treatment. While long-term outcomes of renal surgery were not previously considered, the current demonstration of the significance of long-term renal functional outcomes has drawn another parallel with the considerations in prostate cancer surgery. The argument for conservative management of kidney cancers may be even more compelling than that of prostate cancer, given an increased understanding of the morbidity of surgical treatment of renal cancers on kidney functional and other important nononcologic outcomes.

In this issue, it is our desire to demonstrate the multifactorial, multidisciplinary thought process involved in the contemporary management of the renal mass. Given the variable biological behavior of renal cancers, the paradigm of removing a mass simply because it is identified should no longer be part of the urologist’s practice.

While evolution of the treatment paradigm for renal cancer has evolved in many ways, in this issue, we focus on a few particular themes. First, we attempt to create an evidence-based methodological approach to the small renal mass. In the article by Kang and colleagues, the authors discuss novel imaging approaches that may tell us something about the tumor before we biopsy or remove it. As imaging technology continues to provide more tumor-specific diagnostic information, treatment plans become individualized to the patient and tumor. The article by Deng and coworkers, on the significance of the histology of renal cancers, should allow an understanding of the variable biology of the disease. Finally, the article by Kim and colleagues provide a cohesive strategy for approaching the small renal mass at the time of diagnosis.

A second theme of the issue is that of surgical planning and the number of factors that currently go into the selection of the treatment approach. Once the decision for treatment is made, both host factors and tumor-related factors must be considered in developing an optimal individual approach to the tumor. In the article by Sivarajan and coworkers, current treatment trends in the utilization of nephron-sparing and minimally invasive procedures, as well as factors driving utilization, are reviewed. The article by Shuch and colleagues discusses the management of multifocal tumors, and the article by Lane and coworkers discusses the influence of individual treatment strategies on renal function and offers advice on how this information should be used in selecting the surgical approach. The articles by Kheterpal and colleagues and Faddegon and colleagues review the outcomes of various nephron-sparing approaches.

The final theme of this issue is to define a role for the urologist in the management of advanced renal cell carcinoma. The recent FDA approval of a number of biologic agents, efficacious in the treatment of metastatic disease, has rejuvenated the interest of medical oncologists in kidney cancer. It remains of critical importance that urologists maintain a firm grounding in their knowledge of available agents, factors influencing treatment, and the role of surgery within a multidisciplinary treatment strategy. In the article by Kenney and coworkers, the role of surgery in the era of tyrosine kinase inhibitors is discussed, and in the article by Hu and coworkers, a comprehensive individualized strategy for advanced disease is suggested. The introduction of new agents into the management of advanced disease has brought with it many questions regarding sequence of therapy, selection of agent, and the role of surgery. We are confident that these articles will be helpful in guiding the reader through these complex issues.

As guest editors of this issue, our goal was to provide the reader with a valuable resource which familiarizes the reader with the current thinking and decision-making thought processes that have evolved over time for the treatment of all stages of renal cancer. We are extremely grateful for the hard work and effort of the authors of this issue. As recognized leaders in this field, their time is appreciated and their insight is invaluable.