Abstract
Increasing life expectancy has led to a rise in the number of elderly patients with incidental small renal masses (SRMs). These tumors often show slow growth and can be safely monitored in selected cases. Studies demonstrate effective oncological control through active surveillance in elderly patients, particularly in those with low tumor progression and significant comorbidities. Histological subtype impacts growth behavior and metastatic potential. While a biopsy may help to avoid overtreatment, its value must be critically assessed in older patients. Surgical treatment, including partial and radical nephrectomy, remains associated with acceptable complication rates even in the very elderly, particularly in high-volume centers. However, studies show that surgical intervention does not necessarily confer a survival advantage in this population. Minimally invasive and ablative approaches, such as cryo- and microwave ablation, are gaining importance, especially in patients with increased frailty or impaired renal function. The use of geriatric assessments, particularly the G8 score, helps to identify vulnerable individuals and supports individualized treatment decisions. Age alone should not be a contraindication to oncological therapy but should prompt a careful risk-benefit assessment. The goal must be a personalized, risk-adapted therapeutic approach that balances quality of life, functional preservation, and oncological control.