Symptoms of Renal Cell Carcinoma in Men
Most men with renal cell carcinoma are asymptomatic and diagnosed incidentally on imaging, but when symptoms occur, hematuria is the most common presenting feature, followed by flank pain and a palpable abdominal mass—though the classic triad occurs in less than 10% of patients and indicates advanced disease with poor prognosis. 1
Incidental Detection vs. Symptomatic Presentation
- More than 50% of RCCs are currently detected incidentally during abdominal imaging (ultrasonography, CT, or MRI) performed for unrelated reasons 2
- The shift toward incidental detection reflects the widespread use of cross-sectional imaging in modern medical practice 2
- When symptoms do occur, they typically indicate more advanced disease with worse outcomes 1
Classic Symptomatic Triad (Advanced Disease)
The traditional triad occurs in less than 10% of patients and suggests advanced disease: 1
- Gross hematuria (blood in urine)—the most common symptom when present, indicating local tumor extension or invasion 1
- Flank pain—suggests local tumor extension or invasion 1
- Palpable abdominal or flank mass—indicates substantial tumor burden 1
Among symptomatic patients, 60% present with gross hematuria as one symptom, and 36% have two components of the triad 3
Metastatic Symptoms
When RCC has spread beyond the kidney, men may present with: 2
- Bone pain from skeletal metastases 2
- Lung nodules or respiratory symptoms (lungs are the most common metastatic site, occurring in 50-60% of relapses) 4
- Neurological symptoms from brain metastases 2
Paraneoplastic Syndromes
RCC can produce systemic symptoms unrelated to tumor location: 1
- Hypercalcemia from parathyroid hormone-related peptide secretion—a common paraneoplastic manifestation 1
- Unexplained fever without infection 1
- Erythrocytosis from erythropoietin production 1
- Stauffer's syndrome (cholestatic liver dysfunction without hepatic metastases)—a rare paraneoplastic manifestation 1
- Weight loss and wasting syndromes 2
Male-Specific Warning Sign
- New-onset varicocele in an older male should raise immediate suspicion for RCC, as it may indicate renal vein or inferior vena cava obstruction by tumor 1
- This finding warrants urgent abdominal ultrasonography followed by contrast-enhanced CT for definitive staging 1
Constitutional Symptoms
Non-specific systemic symptoms include: 5, 6
- Weight loss
- Night sweats
- Fatigue
- General malaise
Clinical Pitfalls
The absence of symptoms does not exclude RCC—in fact, asymptomatic presentation is now the norm rather than the exception 2, 3. Up to 25-30% of patients already have metastases at diagnosis despite being asymptomatic 3. This underscores the importance of investigating incidental renal masses found on imaging performed for other indications, as these represent opportunities for early detection and cure 3.