Chest Imaging After RCC Surgery Not Warranted

SURVEILLANCE chest imaging for patients following surgical excision for localized renal cell carcinoma (RCC) is not warranted, investigators reported during the AUA2021 Virtual Experience.

“There seems to be minimal clinical value in surveillance for pulmonary recurrence after resection of T1a renal cell carcinoma,” investigator David K. Charles, MD, of the Medical College of Wisconsin in Milwaukee, said during an oral presentation.

Cancer recurs in 20% to 30% of these patients, with 50% to 60% of recurrences being lung metastases, according to the investigators. Previous studies have revealed an extremely low incidence of lung metastases in T1-T3 RCC following surgical excision, they noted. Still, clinical guidelines from the National Comprehensive Cancer Network and the AUA recommend that patients who undergo surgical excision of localized RCC have surveillance chest X-rays performed at least annually for 5 years.

Dr Charles and his collaborators retrospectively analyzed 463 patients who underwent surgical excision of T1a RCC from January 2000 to January 2020. The study excluded patients with pathology other than RCC and those with pulmonary nodules on baseline imaging. The patients had a mean age of 58.3 years. The mean follow-up duration was 47.6 months.

On the most recent pulmonary surveillance imaging, 335 patients (72.4%) had a chest X-ray and 128 (27.6%) had chest computed tomography scans. Regardless of imaging modality, pulmonary recurrence was not detected in any patient. ■

B:7.25" T:7" S:6.75"

Few Patients Stay on PTNS Long Term

PATIENTS RARELY continue percutaneous tibial nerve stimulation (PTNS) for overactive bladder (OAB) after 3 years, according to new study ndings presented during the AUA2021 Virtual Experience.

Of 146 patients treated with PTNS from 2014 to 2017 at Stony Brook Medical Center in Stony Brook, New York, 108 patients (74%) completed the initial 12-week course of therapy, but only 76 (52%) continued with monthly maintenance therapy. After 3 years, only 16 patients (11%) still underwent PTNS, Chris Du, MD, and colleagues from Stony Brook Medicine reported in a poster presentation. The median duration of PTNS therapy was 147 days.

In multivariate analysis, only symptom improvement and neurological history were signi cantly associated with continuing PTNS. Symptom improvement was reported by 100% of patients who remained on PTNS at 3 years compared with 60% of patients who dropped out.

The most commonly cited reasons for cessation included worsening of urinary symptoms (51 patients), time commitment (12), request for alternative treatment (12), medical comorbidities (10), and insurance issues (7). ■