The epidemiological signature of renal cell carcinoma (RCC) shows a sustained increase in incidence coupled with stable mortality;1 this signature is most probably explained by overdetection of cancers not destined to cause death superimposed on stable occurrence. Furthermore, clinical practice suffers from pursuing management of localized renal masses without knowledge of histology.2 As a result of this uncertainty, increased surgical treatment of small renal masses (SRMs) is performed at the expense of limited use of active surveillance.2,3 Therefore, surgery might become a potential harm of excessive cross-sectional imaging.4