The object was to investigate the long-term prognosis and prognostic factors, symptoms and change in diagnostics among renal cell carcinoma (RCC) patients. Information was collected from the original medical records of 970 patients diagnosed between 1964 and 1997, the longest follow-up being 35 years. Primarily metastatic disease was found in 26% of patients, 30% relapsed during follow-up, some even after 20 years. After 25 years only 26% of patients were alive. Stage, age and symptomatic disease were the most important prognostic factors. The clinical presentation proved a stronger prognostic factor than BMI. Smokers had poorer survival in localized tumors than non-smokers. RCC tumors are nowadays more often small and of lower stage than those diagnosed before computed tomography and ultrasound came into general use. In this study only 12% of tumors were <3.0 cm in diameter. These tumors were more often asymptomatic and had better prognosis than larger tumors. The most common symptoms of RCC were flank pain, hematuria and high erythrocyte sedimentation rate (ESR). During the study period, the incidence of hematuria and high ESR decreased, but there was no change in other symptoms.