Life expectancy (LE) for patients presenting with newly diagnosed renal cell carcinoma (RCC) is often lower compared to the normal population irrespective of RCC. This observation has prompted the diffusion of active surveillance as a reasonable option in cases with limited LE and features of non-aggressive disease to reduce overtreatment. On the other hand, radical treatment should be avoided in a frail population, because radical nephrectomy (RN) is an independent predictor of cardiovascular events, of renal insufficiency leading to end-stage renal disease and of other comorbidities, which will further shorten LE (10 to 30% of patients die within the first year of dialysis).