BACKGROUND AND OBJECTIVE: The European Association of Urology (EAU) renal cell carcinoma (RCC) guideline panel has updated their evidence-based guidelines and recommendations for the management of RCC. Here we present a summary of the 2025 RCC guidelines updated with standardised methodology to provide reproducible evidence for the management of RCC. METHODS: For the 2025 update, a literature search was performed covering the period from May 1, 2023 to May 1, 2024 using the Medline, EMBASE, and Cochrane Libraries. The data search focused on meta-analyses, systematic reviews, randomised controlled trials (RCTs), and retrospective or controlled comparator-arm studies. Evidence was synthesised as outlined for all EAU guidelines. KEY FINDINGS AND LIMITATIONS: Clinical practise recommendations were updated in all chapters of the RCC guidelines on the basis of a structured literature search. The studies included were predominantly retrospective with matched or unmatched cohorts based on single- or multi-institutional data. Several prospective studies and RCTs provided data that resulted in recommendations based on higher levels of evidence. Specifically, updates include new recommendations on stereotactic body radiotherapy for localised RCC, adjuvant therapy, systemic therapy for clear-cell RCC in later lines, other subtypes, and a new chapter on hereditary RCC. CONCLUSIONS AND CLINICAL IMPLICATIONS: The 2025 RCC guidelines have been updated by a multidisciplinary panel of experts using methodological standards to provide a contemporary evidence base for the management of RCC.

Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden

Department of Cancer Medicine Gustave Roussy Université Paris Saclay Villejuif France

Department of Experimental and Clinical Medicine University of Florence Florence Italy; Unit of Urology and Renal Transplantation Careggi Hospital Florence Italy

Department of Surgical Oncology Institut Paoli Calmettes Marseille France

Department of Translational Medicine Division of Urological Cancers Lund University Malmö Sweden

Department of Urology and Transplantation Surgery and Eva Mayr Stihl Cancer Center Klinikum Stuttgart Stuttgart Germany

Department of Urology Chaim Sheba Medical Center Tel Hashomer Ramat Gan Israel

Department of Urology Coimbra University Hospital Coimbra Portugal

Department of Urology Helios Hospital Bad Saarow Germany; Faculty of Health Sciences Brandenburg Brandenburg Medical School Theodor Fontane Brandenburg Germany

Department of Urology Odense University Hospital and Department of Clinical Research University of Southern Denmark Odense Denmark

Department of Urology San Raffaele Scientific Institute Milan Italy; Division of Experimental Oncology Unit of Urology Urological Research Institute IRCCS San Raffaele Hospital Milan Italy

Department of Urology University Hospital Pilsen and Faculty of Medicine in Pilsen Charles University Pilsen Czechia

Department of Urology University of Eastern Piedmont Maggiore della Carità Hospital Novara Italy

Division of Surgery and Interventional Sciences University College London London UK; Specialist Centre for Kidney Cancer Royal Free Hospital London UK

Division of Urology Department of Translational Medicine University of Eastern Piedmont Maggiore Della Carità Hospital Novara Italy

European Association of Urology Arnhem The Netherlands

Homerton University Hospital London to now Addenbrooke's Hospital Cambridge UK

Royal Free London NHS Foundation Trust London UK; Division of Surgery and Interventional Science University College London London UK; Department of Urology The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Royal Free NHS Trust and Barts Cancer Institute Queen Mary University of London London UK

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