Abstract

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• Surgical excision is the gold standard therapy for clinically localized renal masses. Nevertheless, prognostication of the natural history of untreated renal cell carcinoma (RCC) remains a clinical challenge. While active surveillance (AS) has emerged as a viable treatment option in select patients with localized tumors and significant competing mortality risks, long term follow up data to assess the risk of disease progression are limited. We present a case of a localized, clinical stage T2 renal mass progressing to regional and systemic disease over 6 years, demonstrating that kinetics of disease progression may be prolonged and are yet to be fully understood.