European Association of Urology Guidelines on Renal Cell Carcinoma: The 2025 Update
- Study type
- Clinical guideline
- Study name
- EAU RCC 2025
- Design
- Clinical guideline based on a systematic literature review (standard EAU guideline methodology)
- Source
- Eur Urol · 2025
In plain words
This guideline from the European Association of Urology is the society's latest official summary on diagnosing and treating kidney cancer: from monitoring small masses and kidney-sparing surgery to immunotherapy after surgery and drug treatments for advanced disease.
Key guideline recommendations
- Strong
Increasing physical activity, stopping smoking and weight loss in people with obesity are the main preventive measures to reduce the risk of RCC.
- Strong
Perform genetic assessment in patients aged 46 years or younger and in patients with bilateral or multifocal tumours.
- Strong
Offer partial nephrectomy to patients with T1 tumours.
- Weak
Offer active surveillance to cT1a patients who do not need immediate treatment and for whom delayed intervention is appropriate; offer tumour ablation or stereotactic radiotherapy to patients with cT1 lesions who need treatment but are unfit for surgery.
- Strong
Offer adjuvant pembrolizumab to patients with ccRCC at risk of recurrence as defined in the KEYNOTE-564 trial (intermediate-high risk, high risk, or M1 with no evidence of disease after metastasectomy).
- Strong / Weak
Do not perform cytoreductive nephrectomy in poor-risk patients; in intermediate-risk patients with an asymptomatic primary tumour who require systemic therapy, start systemic therapy without immediate nephrectomy.
- Strong
In IMDC intermediate- or poor-risk metastatic clear-cell RCC, offer one of the combinations pembrolizumab + axitinib, lenvatinib + pembrolizumab, nivolumab + cabozantinib or nivolumab + ipilimumab.
- Strong
Offer sunitinib or pazopanib to patients who cannot receive or do not tolerate an immune checkpoint inhibitor.
- Strong
Offer cabozantinib or another VEGF-TKI as second-line treatment to patients refractory to immunotherapy-based combinations.
- Weak
Offer belzutifan as an alternative to everolimus in patients who have previously received second- to fourth-line treatment.
Study population
Adults with renal cell carcinoma, from small masses and localised disease to advanced and metastatic disease and hereditary forms.
Endpoints
Recommendations are given with a strength of "Strong" or "Weak", and evidence summaries with a level of evidence.
Clinical significance and place in guidelines
The 2025 update has new recommendations on stereotactic radiotherapy for localised RCC, adjuvant therapy (strong recommendation for adjuvant pembrolizumab), later-line systemic therapy, non-clear-cell subtypes and a new chapter on hereditary RCC. The full, current version of the guideline on the EAU website is updated annually.
Limitations
The abstract is a general summary. The text of the recommendations on this card is quoted from the full EAU guideline (current version published on the society's website, limited update March 2026), and its details may differ slightly from the 2025 summary paper. Most of the supporting evidence is retrospective.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.