Purpose <p>Prevalence<?tk 2?> of the classic triad of hematuria, flank pain and abdominal mass among renal cell carcinoma (RCC) patients appears to be declining, while incidence of RCC has increased. In addition, the relationship between symptomatic presentations and patient outcomes remains unclear. A contemporary analysis could provide insights into the stage-specific epidemiology of RCC symptoms and clarify impact on survival.</p> Methods <p>RCC patients<?tk 2?> diagnosed between 2004 and 2017 were identified using SEER-Medicare data. Claims-based presentation of hematuria, abdominal pain, or abdominal mass within the preceding 12 months prior to diagnosis was captured. Multivariable logistic regression models were utilized to examine the relationship between patient characteristics and symptomatology. Survival outcomes were assessed using multivariable proportional hazards regression.</p> Results <p>Among 47,369 RCC<?tk 2?> patients, 68.6% exhibited at least one symptom. Symptomatic patients decreased over time (<i>p</i> &lt; 0.001). The classic triad of symptoms was observed in only 2.9% of patients and slightly more prevalent in later stage disease. Only those with the triad and abdominal mass specifically had increased risk of death [aHR 1.14 (95% CI 1.07–1.21) and aHR 1.05 (95% CI 1.01–1.08), respectively]. Five-year survival rates for patients with and without the symptom triad were 53.78% and 44.61% respectively.</p> Conclusion <p>Although<?tk 2?> a significant proportion of RCC patients may present with symptoms, the classic triad is rare. Presence of abdominal pain and hematuria symptoms alone did not demonstrate effect on survival rates. Decrease in symptomology and increase in the proportion of AJCC Stage 1 disease over time may be attributed to incidental detection.</p>