1. INTRODUCTION
1.1. Aims and scope
The European Association of Urology (EAU) Renal Cell Cancer (RCC) Guidelines Panel has compiled these clinical guidelines to provide urologists with evidence-based information and recommendations for the management of RCC.
It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and references/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.
1.2. Panel composition
The EAU Guidelines Panel on RCC consists of an international multidisciplinary group of clinicians, including urological surgeons, oncologists, methodologists, a pathologist and a radiologist, with particular expertise in the field of renal cancer care. Since 2015, the Panel has incorporated a patient advocate to provide a consumer perspective for its guidelines. All experts involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU website Uroweb:
http://uroweb.org/guideline/renalcellcarcinoma/.
1.3. Available publications
A quick reference document, the Pocket Guidelines, is available in print. This is an abridged version which may require consultation together with the full text version. Several scientific publications are available and all documents are accessible through the EAU website Uroweb: http://uroweb.org/guideline/renal-cell-carcinoma/.
A EAU Guidelines App for iOS and Android devices is also available containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, guidelines cheat sheets and links to the extended guidelines.
1.4. Publication history and summary of changes
1.4.1. Publication history
The EAU RCC Guidelines were first published in 2000. This 2025 RCC Guidelines document presents a limited update of the 2024 publication.
1.4.2. Summary of changes
All chapters of the 2025 RCC Guidelines have been updated, based on the 2024 version of the Guidelines. References have been added throughout the document. Other key changes incorporated in this publication includes:
- A new summary of evidence (SoE) in section 5.4 on lung metastises in cT1a, cN0 patients.
- A new figure 7.1 on the treatment of locally advanced RCC and update on Figure 7.2.
- A new subchapter and recommendation regarding smoking cessation in chapter 7.1.2
- A new SoE and recommendation on stereotactic body radiotherapy (SBRT) in section 7.2.4.4.8
- Inclusion of arm B data for Checkmate 914 in table 7.1
- A new subchapter 7.3.5.5 on the progression after adjuvant PD-1 therapy.
- Update on the SoE and recommendations in section 7.3.5.6 for neoadjuvant and adjuvant therapy.
- Update on the SoE in chapter 7.5.2.5 regarding belzutifan.
- Update of table 7.5 regarding RENOTORCH data and update of the SoE and recommendations in section 7.5.4.1.2
- Update on the SoE and recommendations in section 7.5.4.2.4 for systematic therapy in chromophobe and unclassified RCC.
- A new subchapter 8 including Table 8.1 on hereditary and syndrome specific RCC.