OBJECTIVE We evaluated the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured using pretreatment F-FDG PET/CT in patients with renal cell carcinoma (RCC). METHODS A total of 139 patients with RCC who had undergone FDG PET/CT before tumor resection were retrospectively reviewed. We determined the SUVmax, MTV, and TLG and compared the results obtained with those required for a progression-free survival (PFS), which was defined as disease progression. Receiver operating characteristic curve analysis was used to compare prediction accuracies. Univariate and multivariate analyses of conventional clinicopathologic variables (age, sex, pathological tumor node metastasis [pTNM] stage, histological type, Fuhrman grade, and presence/absence of microscopic lymphatic and venous invasions) were used to compare the reliability of the metabolic parameters (SUVmax, MTV, and TLG). RESULTS Of the 139 patients, 24 patients (17%) experienced disease progression during the follow-up period. The age, pTNM stage, Fuhrman grade, presence/absence of microscopic lymphatic and venous invasions, SUVmax, MTV, and TLG were found to be significant prognostic factors for PFS (P < 0.05) on univariate analyses. Multivariate analyses revealed that MTV, TLG, and high pTNM stage (P = 0.02 [hazard ratio, 9.5; 95% confidence interval, 1.50-187.0], P = 0.02 [hazard ratio, 9.0; 95% confidence interval, 1.40-178.5], P = 0.004 [hazard ratio, 5.9; 95% confidence interval, 1.66-20.4], respectively) were the significant predictors after adjustment for other variables of PFS. CONCLUSIONS The pretreatment value of MTV, TLG, and high pTNM stage are the significant prognostic factors in patients with RCC.