Purpose-We sought to determine whether a relationship exists between primary tumor size and histopathologic features in localized renal cancers.Materials and Methods-Data from Surveillance, Epidemiology and End Results (SEER) were used to create a cohort of patients diagnosed with localized, node negative renal masses from 1988-2004. Nuclear grade was divided into "low" and "high" grade groups. We used a multinomial logistic model to predict the probability of nuclear grade and histologic subytpe with increasing size of the primary tumor.Results-19,932 patients in SEER with localized renal masses were evaluated. The overall nuclear grade distribution was 80% and 20% for low and high grade tumors respectively. A multinomial logistic model reveals that the probability of a high grade tumor increases with size. For each 1 cm increase in size of a primary localized RCC, the odds of high grade disease increases by 13% (OR=1.13, p<0.001). Multinomial models also predict that the odds of papillary RCC compared to clear cell RCC decreases with tumor size. Conversely, the odds of chromophobe RCC versus clear cell RCC increases with increasing tumor size.Conclusion-The majority of localized, node negative RCCs are low grade tumors. Although the probability of a high grade tumor increases with size, nearly 85% of RCC <4cm and 70% of localized RCC >7cm demonstrate low nuclear grade. The probability of detecting particular histologic subtypes also varies with increasing tumor size. These data suggest that many localized renal tumors can grow very large locally without acquiring metastatic potential.

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Brain activity changes as well as the areas of activation after treatment of lower urinary tract symptoms in patients with an anticholinergic medication or placebo are different in the 2 groups. Whether this finding represents action at the central nervous system or the bladder level is not known.

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