The number of new cases of renal cell carcinoma has been steadily increasing since the 1960s, reaching 62,000 and 89,000 annually in the United States and Europe, respectively, in 2016. The current standard of care for early-stage disease is nephron-sparing surgery, which has a demonstrated long-term disease-free survival and an acceptable safety profile. Technical developments (thin, powerful probes and real-time image guidance systems) have allowed image-guided percutaneous ablation to become a viable option for stage I renal cell carcinoma. Because of the widespread use of cross-sectional imaging, most renal tumors (75%) are indeed detected incidentally at stage I (75%). As a result, ablation is a potentially curable intervention and one that could mitigate surgical risks. All 3 ablative modalities (radiofrequency ablation, microwave ablation, and cryoablation) have been extensively applied. The utilization of ablation was initially hampered by the lack of prospective, long-term oncologic data. As a result, ablation was reserved for specific subgroups of patients, for example, patients with solitary kidney, chronic kidney disease, or bilateral disease; poor surgical candidates; or patients with syndromes that predispose them to renal cell cancer. Recently, however, studies on percutaneous ablation for early-stage renal cancer have yielded prospective, long-term oncologic data, affirming the earlier, lower-level-evidence studies. The reported efficacy of ablation for stage I renal cancer (especially cryoablation) appears to rival that of the accepted standard of care (nephron-sparing surgery), whereas its safety profile is a decided advantage. In conclusion, image-guided percutaneous ablation should be considered a viable, curative option for stage IA renal cell carcinoma.