Editing Management of Localized and Locally Advanced Disease (section)

==== Schedule ====

===== AUA =====
* <span style="color:#ff0000">[https://pubmed.ncbi.nlm.nih.gov/28479239/ '''2021 AUA Guidelines on Renal Mass and Localized Renal Cancer''']</span>
** '''<span style="color:#ff0000">See [https://www.auanet.org/documents/Guidelines/PDF/RCC-Follow-Up-Algorithm.pdf Table 1] from Original 2021 AUA Guidelines'''
***'''<span style="color:#ff0000">If low-risk, abdominal and chest imaging at 12, 24, 48 and 60 months'''
*** '''<span style="color:#ff0000">If intermediate-risk, abdominal and chest imaging at 6, 12, 24, 36, 48 and 60 months'''
** '''Imaging for at least 5 years'''
*** '''Abdominal'''
**** '''After 2 years, abdominal ultrasound (US) alternating with cross-sectional imaging may be considered in the low- and intermediate-risk groups at physician discretion.'''
**** '''After 5 years, informed/shared decision-making should dictate further abdominal imaging.'''
***** The option to use abdominal US instead of CT or MRI s intended to allow continuous monitoring after 5 years, while minimizing radiation exposure/cost in the LR and IR groups.
*** '''Chest'''
**** '''Modality'''
***** '''Chest x-ray low- and intermediate-risk groups'''
***** '''CT chest for high and very high-risk groups.'''
**** After 5 years, informed/shared decision-making discussion should dictate further chest imaging and chest x-ray may be utilized instead of chest CT for high and very high-risk groups.

===== CUA =====
*'''2018 CUA'''
** '''See Table 1 from Original Guideline for Surveillance Schedule'''
** '''If patient is symptomatic or has an abnormal blood test, earlier radiological investigations may be indicated'''
** '''Low-risk (pT1)'''
*** '''Abdominal imaging (CT/MRI/US) is recommended at 24 and 60 months'''
**** US is less sensitive than CT, however, its use is justifiable and cost-effective in patients with a minimal risk of abdominal recurrence and lower BMI
*** '''Follow-up is the same for PN for lesions <4 cm,''' since local recurrence rates in this population are similar to RN
**** '''Postoperative CT abdomen at 3–12 months is optional for patients treated with PN to evaluate the residual baseline renal appearance'''
*** '''Routine imaging beyond 5 years is optional and can be risk-adapted'''
** '''Intermediate-risk (pT2)'''
*** '''Abdominal imaging (CT/MRI/US) recommended at 12, 24, 36, and 60 months'''
*** '''Routine imaging beyond 5 years is at the discretion of the treating physician'''
** '''High-risk (pT3-4)'''
*** '''Abdominal CT or MRI is recommended every 6 months for 2 years, then at 36 and 60 months, then every 2 years'''
** '''Very high-risk (N+)'''
*** '''Abdominal CT or MRI is recommended at 3 and 6 months, then every 6 months for 3 years, then yearly'''
** '''Imaging'''
*** '''Abdomen'''
**** '''CT abdomen/pelvis recommended,''' particularly in cases of tumour-associated symptoms
***** '''Abdominal US may be performed for lower-risk patients (pT1 and pT2)'''
*** '''Chest'''
**** '''Modality'''
***** '''CXR recommended'''
***** '''CT chest in higher-risk patients''' due to the higher sensitivity of this test compared to CXR
****** Can consider alternating CT chest with CXR