Progression to metastatic disease from a small renal cell carcinoma prospectively followed with an active surveillance protocol.

With the widespread use of abdominal imaging to evaluate other medical conditions, many renal tumours are being diagnosed at earlier stages. Older patients have experienced the most significant increase in the incidence of renal cell carcinoma (RCC). This age group frequently has significant medical comorbidities. This has led to the concept of active surveillance for select patients with renal lesions that may not affect their mortality. However, the ultimate risk of active surveillance is the potential for developing metastases. This case report presents the development of metastatic disease from a small, incidentally detected and prospectively followed RCC with asymptomatic progression.