This review highlights new strategies in the treatment of renal cell carcinoma (RCC). The benign or malignant status of renal masses in preoperative imaging as well as the detection of metastases and their differentiation from secondary malignancies is discussed. For the prognostic stratification of RCC the TNM system has been adopted. Nephron-sparing (NS) techniques of laparoscopy, radiofrequency and cryoablation are critically compared and the newest results of robotic-assisted (DaVinci) NS surgery are given. The special question of cytoreductive surgery in primary metastatic disease and the question of adjuvant immunotherapy are raised. New medical treatment strategies including new substances, vaccines and the possibility of sequential therapy are discussed.