Aggressive renal cell carcinoma (RCC) in young adult men has been increasing significantly at 3% to 5% annually, with the rate doubling from the years 2000 to 2016.2 It’s well known that diseases with genetic drivers or links disproportionally affect adults younger than 40 years of age, but many kidney cancers in this age group do not have currently known genetic causes. Further, young adult men harboring aggressive RCC may not have typical presentation.