AUA2023 was filled with groundbreaking kidney cancer research. There were a total of 120 posters, 72 podiums, 11 video abstracts, 3 plenaries, and 1 late-breaking abstract on kidney cancer. The sessions covered a variety of topics, including new diagnostic tools, updated active surveillance data, surgical studies, and systemic therapy studies. Below a few important abstracts will be highlighted.

One of the most exciting and important abstracts was regarding a new diagnostic tool for clear cell renal cell carcinoma. Girentuximab is a monoclonal antibody that targets carbonic anhydrase IX. In the open-label ZIRCON study ⁸⁹Zr-DFO-girentuximab was administered to patients with a renal mass ≤4 cm and positron emission tomography/CT was performed in 300 patients. ⁸⁹Zr-DFO-girentuximab was both sensitive and specific for clear cell renal cell carcinoma, even across 3 independent readers. Overall sensitivity was 85.5%, specificity 89.5%, and positive predictive value 93.4%.¹ Availability and utilization of this positron emission tomography/CT may allow for improved counseling, as well as avoiding the need for biopsy in those with positive tests. Importantly, this is excellent for identifying clear cell renal cell carcinoma; however, a negative test does not rule out other forms of renal cell carcinoma.

Continuing along the theme of small renal masses, 12-year data from the DISSRM registry were presented. This registry compared active surveillance for small renal masses to primary intervention. They found nearly equivalent cancer-specific survival for those undergoing active surveillance vs primary intervention at 12 years of follow-up. Overall, patients with renal masses <2 cm were very unlikely to cross over to treatment (10.28%), while those with masses >3 cm were more likely to cross over to treatment (25.76%, HR 13.93 [95% CI: 7.25-26.74], P < .01).² Importantly, delayed intervention was safe, with no impact on recurrence-free survival. These data emphasize the safety of monitoring small renal masses. Urologists should continue to engage in shared decision-making with patients, and offer active monitoring as a management strategy, especially for small renal masses <2 cm in size.

Transitioning to advanced renal cell carcinoma, there were several abstracts highlighting cytoreductive nephrectomy in the immune checkpoint inhibitor era. Overall, cytoreductive nephrectomy following immunotherapy is feasible and safe with minimal impact on complications. In 1 study, patients who underwent immunotherapy experienced a decrease in tumor size and complexity, as well as a decrease in size of thrombus. The majority of patients had both negative margins and no postoperative complications (67.9%).³ A second study demonstrated that 9% of patients undergoing cytoreductive nephrectomy following immune checkpoint inhibition experienced a complete pathologic response, with 100% of those patients being disease-free and alive at 3 years of follow-up.⁴ Lastly, cytoreductive nephrectomy in all patients was shown to have an impact on patient-reported outcomes, with an improvement in patient quality of life postoperatively, with less reported worry about cancer progression following cytoreductive nephrectomy.⁵

In summary, it was a pivotal year for kidney cancer with emerging diagnostic tools, long-term data on monitoring small renal masses, and a glimpse of data supporting cytoreductive nephrectomy in the immune checkpoint inhibitor era. It will be interesting to see further developments in these areas to determine the long-term impact on patient care and outcomes.