title: Comparison of Renal Cell Carcinoma Surveillance Guidelines: Competing Trade-Offs.
abstract: We estimated the differences in intensity, cost, radiation exposure and cancer control of published surveillance guidelines screening for secondary renal cell carcinoma in patients treated with partial nephrectomy.
  
  
  
  We developed a Monte Carlo simulation model to contrast the existing guidelines in terms of cost, radiation exposure and cancer control. Model inputs were extrapolated from the existing literature. Surveillance guidelines were analyzed from the AUA, CUA, EAU and NCCN®. Risk stratification among patients treated with partial nephrectomy was based on tumor characteristics.
  
  
  
  Expected costs during the 5 years after partial nephrectomy were $587 (CUA), $1,076 (AUA), $1,705 (EAU) and $1,768 (NCCN) for low risk patients, and $903 (CUA), $2,525 (EAU) and $3,904 (AUA and NCCN) for high risk patients. Radiation exposure ranged from 31.41 mSv (CUA) to 104.34 mSv (NCCN) for low risk patients and 46.88 mSv (CUA) to 231.61 mSv (AUA and NCCN) for high risk patients. The EAU and CUA guidelines led to the diagnosis of the highest percentage of low risk patients (more than 95%) while all guidelines diagnosed more than 92% of high risk patients with recurrence.
  
  
  
  Renal cell carcinoma surveillance guidelines differ greatly in terms of intensity, cost and radiation exposure. It is important for clinicians to adopt standardized surveillance strategies that limit unnecessary cost and radiation exposure without compromising cancer control.
authors.affiliation: Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia. Electronic address: jem4yb@virginia.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Lobo
authors.affiliation: Department of Urology, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Marc
authors.initials: M
authors.lastname: Nelson
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, Virginia.
authors.forename: Naveen
authors.initials: N
authors.lastname: Nandanan
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, Virginia.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Krupski
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000191:economics; D008962:Models, Theoretical; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000191:economics; D017410:Practice Guidelines as Topic; D000069079:Radiation Exposure / Q000706:statistics & numerical data; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014481:United States
keywords: carcinoma, renal cell; computer simulation; diagnostic imaging; practice guidelines as topic; recurrence