Renal cell carcinoma: incidental detection during routine ultrasonography in men presenting with lower urinary tract symptoms

Objective To compare renal cell carcinomas (RCCs) presenting incidentally i n patients referred for lower urinary tract symptoms GLUTS) with those pres enting symptomatically. by stage, intervention and outcome. Patients and methods The case notes of all male patients (100) diagnosed wi th RCC between 1991 and 1998 were reviewed and modes of presentation record ed. The patients were divided into two groups: those who were referred with LUTS (frequency, urgency, hesitancy, poor stream, nocturia) and in whom RC C would not have been suspected and was thus detected incidentally on routi ne ultrasonography; and all patients in whom carcinoma might have been susp ected from their symptoms but, for the purposes of this study, also include d patients in whom RCC was diagnosed during ultrasonography for unrelated i ntra-abdominal pathology. Details of diagnostic imaging and clinical stagin g were similarly recorded for both groups and where surgical intervention w as undertaken, histopathological data were also noted. The clinical course and long-term outcome of incidentally detected tumours was then compared wi th their symptomatically presenting counterparts. Results The mean (range) follow-up for all patients was 30 (1.5-96) months; for those in the incidental group it was 31 (1-86) months and in the sympt omatic patients 29 (1-96) months. Organ-confined disease was found in two-t hirds of patients with incidental tumours and in 38% of those in whom the t umour may have been suspected: the difference was statistically significant (chi-squared test P<0.05). The mean (SD) size Of tumours discovered incide ntally and in symptomatic patients was 5.9 (1.94) cm and 9.2 (3.39) cm, res pectively; this difference was also statistically significant (It-test, P<0 .001). Of the 24 patients with incidentally detected tumours, 14 (58%) were alive with no recurrence, and or the 76 presenting symptomatically, 271 (3 5%) were alive with no recurrence at the last follow-up: disease survival c urves showed a statistically better survival rate for those with organ-conf ined tumours. Conclusion Incidentally diagnosed RCC represents a significant proportion o f those who are ultimately diagnosed with the malignancy. Opportunities whi ch arise for appropriate screening of the upper tracts during routine urolo gical investigations (e.g. ultrasonography of the upper tracts in patients referred for LUTS) should be endorsed, contrasting with the more traditiona l approach, which argues that it yields no ultimate survival advantage.