Testicular Cancer — SCE Medical Oncology MCQ

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EasyUrological CancersTesticular CancerSCE Medical Oncology

A 45-year-old man with a stage I seminoma (pT1, no risk factors) undergoes radical orchidectomy. What is the preferred post-orchidectomy management?

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Correct answer: A — Active surveillance

For stage I seminoma, active surveillance is the preferred option (NICE and ESMO guidelines) with approximately 15-20% relapse rate (nearly all salvageable with chemotherapy or radiotherapy). Single-dose carboplatin AUC 7 (TE19/MRC trial) and adjuvant para-aortic radiotherapy (20 Gy) are alternatives that reduce relapse risk to approximately 4-5% but expose the majority (80-85%) who would never relapse to unnecessary treatment. Surveillance requires patient compliance with regular CT/markers for 5-10 years.

Reference: ESMO 2024 Testicular Cancer Guidelines; NICE NG Testicular cancer pathway; Chung et al JCO 2015