XXXX Surveillance Guidelines: Competing Trade-Offs.

@entity1 @entity5 @entity1358 @entity2073 @entity25438
PURPOSE: We estimated the differences in intensity, cost, radiation exposure and @entity5 control of published surveillance guidelines screening for @entity1358 in @entity1 treated with partial nephrectomy. MATERIALS AND METHODS: We developed a Monte Carlo simulation model to contrast the existing guidelines in terms of cost, radiation exposure and @entity5 control. Model inputs were extrapolated from the existing literature. Surveillance guidelines were analyzed from the AUA, CUA, EAU and @entity25438  . Risk stratification among @entity1 treated with partial nephrectomy was based on @entity5 characteristics. RESULTS: 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 @entity1 , and  903 (CUA),  2,525 (EAU) and  3,904 (AUA and NCCN) for high risk @entity1 . Radiation exposure ranged from 31.41 @entity2073 (CUA) to 104.34 @entity2073 (NCCN) for low risk @entity1 and 46.88 @entity2073 (CUA) to 231.61 @entity2073 (AUA and NCCN) for high risk @entity1 . The EAU and CUA guidelines led to the diagnosis of the highest percentage of low risk @entity1 (more than 95%) while all guidelines diagnosed more than 92% of high risk @entity1 with recurrence. CONCLUSIONS: @entity1358 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 @entity5 control.
