<b><i>Background:</i></b> There is a lack of detailed population-based data for renal cell carcinoma (RCC). <b><i>Objectives:</i></b> The study aimed to examine the contemporary changes in the clinical picture and treatment of RCC. <b><i>Methods:</i></b> A total of 1,719 consecutive patients living in the Helsinki metropolitan area with a solid or cystic renal mass (Bosniak 3–4) ≥10 mm were identified. Data from medical records was evaluated for clinical characteristics and treatments in the periods I (2006–2008), II (2009–2011), III (2012–2014), and IV (2015–2016). <b><i>Results:</i></b> The proportions of patients with comorbidities (Charlson index ≥2) and frailty (Eastern Co-operative Oncology Group classification ≥2) increased significantly during the study period. The percentage of clinical stage I patients, cystic tumors and use of needle biopsies increased significantly. Use of observation increased from 9% (I) to 32% (IV; <i>p </i>&#x3c; 0.001). First-line oncological treatments within 6 months were given to 47% of 262 patients with metastases and ­cytoreductive nephrectomy (CN) was delivered to 54% of those patients. <b><i>Conclusions:</i></b> The size of renal tumors continued to decrease, while the percentage of patients with significant comorbidity or frailty increased. Active surveillance emerged as the initial strategy. Tyrosine kinase inhibitors with CN remained the primary option in patients with metastatic RCC.