Objective: In recent years the incidence of renal cell carcinoma (RCC) diagnosis has increased about 15–20%. It remains to be established whether this increase of incidence is reality or not. The main aim of this study was to analyze the reason for the increase of incidence. Methods: In the present study, 23, 247 autopsies performed in the years 1985–1995 in the area of Jena (Germany) (14,793 autopsies) and Hradec Králové (Czech Republic) (8,454 autopsies) were analyzed. Results: In this autopsy series comprising 23,247 autopsies, the percentage of patients who died of RCC is 1.76% in Jena and 1.55% in Hradec Králové (200,000 inhabitants each). Over this time the incidence of RCC in autopsies has increased. Conclusion: In spite of the increased amount of incidentally found RCCs since beginning widespread use of ultrasonography, the percentage of clinically recognized RCCs in the total of all found RCCs in autopsies is nearly constant over the 11-year period in Jena and 10-year period in Hradec Králové. Thus, the increased number of radical nephrectomies is not only caused by widespread use of ultrasonography. The increasing trend of the incidence of RCC seems to be real.