Active Surveillance of the Small Renal Mass

Inclusion Criteria: * Age ≥ 18 years * Life expectancy \>3 years (by physician estimate) * Measurable, solid renal neoplasm, 1.0 -2.7 cm in size and visible on ultrasound * Clear cell renal cell carcinoma histology * Renal tumor diagnosed within 6 months * Recent biopsy (\<6 weeks) performed, if performed at an outside institution, there must be sufficient material for biomarker analysis * No evidence of vascular invasion or regional nodal/distant disease * Renal tumor that is able to be managed with upfront surgery * Adequate organ function (Hemoglobin \> 9, Absolute neutrophil count (ANC) ≥ 1500/μL Platelets ≥ 100,000/μL, AST and ALT ≤3.0 upper limit of normal (ULN), total bilirubin ≤ ULN, eGFR ≥ 30 * Good Performance status (ECOG ≤2) * Understanding and willingness to provide consent Exclusion Criteria: * History of a hereditary renal cancer syndrome * Tumor \>2.7 cm, stages T1b-T4 * Life expectancy \<3 years * Presence of an active, untreated, metastatic non-renal malignancy * Uncontrolled medical illness including infections, hypertension, arrhythmias, heart failure, or myocardial infarction within 6 months that would predispose to immediate surgical therapy * Medical contraindication to upfront surgical management of renal mass * History of bleeding diathesis or recent bleeding episode that would prevent surgical resection * Unwillingness to undergo monitoring and imaging studies