A 35-year-old man undergoes radical orchidectomy for a 3.5 cm pure seminoma confined to the testis with no lymphovascular invasion (stage I). CT chest/abdomen/pelvis is negative. Which is the most appropriate management after orchidectomy?

• A Retroperitoneal lymph node dissection (RPLND)
• B Adjuvant chemotherapy with one cycle of carboplatin AUC x 7
• C Radiotherapy to the para-aortic lymph nodes
• D Surveillance with serial CT and tumor markers ✓

Explanation

Surveillance is the preferred management for stage I seminoma post-orchidectomy, as most patients are cured by orchidectomy alone and surveillance detects relapse early with excellent salvage rates. Adjuvant carboplatin and radiotherapy are alternatives for those who decline surveillance but carry treatment-related morbidity. RPLND is not indicated for pure seminoma.

Reference: Campbell-Walsh-Wein Urology, 12th ed.

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