Most patients diagnosed with a small renal mass (SRM) undergo definitive treatment, but active surveillance may be offered as an alternative. Our aim was to determine patient preferences regarding management of their SRM.
In this multicenter prospective pilot study, we conducted structured online interviews with patients with a new SRM diagnosis. During the interviews, patients reviewed outcome data and stated their preference for definitive treatment (thermal ablation vs partial nephrectomy). Then the patients reviewed hypothetical scenarios in a ping-pong approach and chose the maximum change in the probability of death from kidney cancer they would be willing to accept in order to decline definitive treatment.
Of the 41 participants interviewed, 71% (n = 29) preferred thermal ablation over surgery. While the median maximum increase in the probability of death from kidney cancer that patients were willing to accept to decline definitive treatment was 0.1% (interquartile range 0.1-2.5%) at 5 yr, 27% of patients reported a threshold ≥2%. Most patients (97%) preferred to review data in the form of a "reduction in the risk of death", rather than an "increase in the risk of death", or expressed no preference. Limitations include the small sample size.
This pilot study demonstrates the feasibility of an innovative approach for evaluating the preferences of patients with SRMs and establishes a robust methodology for future studies. Results highlighted a strong preference for thermal ablation and for presenting data in terms of the reduction in mortality risk. Larger studies are required to validate our findings.
European urology focus. 2025 Aug 18 [Epub ahead of print]
Clara Diaz, Maryam Kandi, Philippe D Violette, Matthieu Gratton, Steven E Hanna, Amélie Tétu, Gordon Guyatt, Patrick O Richard
Research Program in Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada; Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada., Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada., Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Woodstock Hospital, McMaster University, Woodstock, Canada., Hotel-Dieu de Lévis, Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, Canada., Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada., Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada., Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada. Electronic address: .