What follow-up tests are recommended for patients after kidney cancer treatment?

Follow-up Testing After Kidney Cancer Treatment

Patients with treated malignant renal masses require risk-stratified surveillance with periodic history, physical examination, laboratory testing (serum creatinine, eGFR, urinalysis), and cross-sectional imaging (CT or MRI with contrast) of the chest and abdomen, with the frequency and duration determined by tumor stage and risk of recurrence. 1

Core Surveillance Components

All patients with treated malignant renal masses should receive:

• Medical history and physical examination at intervals determined by risk stratification 1
• Laboratory monitoring including serum creatinine, estimated glomerular filtration rate, and urinalysis at each visit 1
• Additional labs (complete blood count, lactate dehydrogenase, liver function tests, alkaline phosphatase, calcium) only at clinician discretion or when advanced disease is suspected 1

Risk-Stratified Imaging Protocols

Stage I (pT1a and pT1b) After Nephrectomy

Clinical visits and labs:

• Every 6 months for 2 years, then annually up to 5 years 1

Abdominal imaging (CT, MRI, or ultrasound):

• Baseline scan within 3-12 months after surgery 1
• After radical nephrectomy: further abdominal imaging beyond 12 months at physician discretion 1
• After partial nephrectomy: annual abdominal scans may be considered for 3 years based on individual risk factors 1

Chest imaging:

• Yearly chest radiograph or CT for 3 years, then as clinically indicated 1

Stage II-III After Radical Nephrectomy

Clinical visits:

• Every 3-6 months for 3 years, then annually up to 5 years 1

Laboratory testing:

• Every 6 months for 2 years, then annually up to 5 years 1

Imaging (chest CT and abdominal CT/MRI):

• Baseline within 3-6 months after surgery 1
• Every 3-6 months for at least 3 years, then annually up to 5 years 1
• CT is preferred over ultrasound for high-risk patients due to superior sensitivity for recurrence detection 1

After Ablative Therapy (Stage pT1a)

Abdominal imaging (CT or MRI with or without IV contrast):

• At 3 and 6 months to assess treatment response 1
• Then annually for 5 years 1

Chest imaging:

• Annual chest radiograph or CT for 5 years in patients with biopsy-proven RCC 1

Symptom-Directed Imaging Only

Bone scan should be performed ONLY when one or more of the following is present: 1

• Bone pain
• Elevated alkaline phosphatase
• Radiographic findings suggestive of bony neoplasm

Without these findings, bone scan yield is very low (routine screening not recommended) 1

Brain/spine imaging (MRI or CT) should be obtained ONLY with: 1

• Acute neurological signs or symptoms
• MRI is more sensitive than CT for small CNS lesions 1

PET scan should NOT be obtained routinely but may be considered selectively in specific circumstances 1, 2

Important Caveats

Duration of surveillance: Follow-up extends for at least 5 years, with continuation beyond 5 years at physician discretion, as some relapses occur after 5 years 1

Positive surgical margins: If microscopic margins are positive, consider the risk category at least one level higher and increase surveillance intensity 1

Benign pathology: Patients with pathologically-proven benign masses require only occasional clinical evaluation and laboratory testing for treatment sequelae; most do not need routine periodic imaging 1

Nephrology referral: Consider referral to nephrology to prevent further renal function deterioration, which affects bone health, metabolic health, and cardiovascular risk 1

Radiation exposure: An abbreviated CT protocol (chest and upper abdomen to L3-L4 level) detects 94% of recurrences while reducing radiation exposure by 48% compared to full chest/abdomen/pelvis CT 3