A 35-year-old man undergoes orchiectomy for a right testicular tumor. Histopathology shows a pure seminoma with tumor confined to the testis, no lymphovascular invasion, and all post-orchiectomy tumor markers normalise. CT staging shows no retroperitoneal lymphadenopathy. What is the preferred management for clinical stage I pure seminoma?
- A Retroperitoneal lymph node dissection (RPLND)
- B Adjuvant chemotherapy with BEP x 3 cycles
- C Active surveillance ✓
- D Adjuvant carboplatin x 2 cycles
Explanation
For clinical stage I pure testicular seminoma with normalized post-orchiectomy tumor markers, active surveillance is the preferred approach for low-risk patients (no rete testis invasion, tumor size <4cm), given that 80-85% of patients are cured by orchiectomy alone and surveillance avoids unnecessary toxicity. Adjuvant options (single-cycle carboplatin or para-aortic radiotherapy) reduce recurrence risk but do not improve overall survival compared to surveillance with rescue chemotherapy at relapse. Surveillance requires regular CT scans and tumor marker checks. RPLND is rarely used for pure seminoma due to excellent response to chemotherapy at relapse.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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