Stage I Seminoma Management — RACP Adult Medicine MCQ

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ModerateMedical OncologyStage I Seminoma ManagementRACP Adult Medicine

A 45-year-old man presents with a painless testicular mass. Ultrasound confirms a solid hypoechoic lesion. He undergoes radical inguinal orchidectomy. Histology shows pure seminoma, stage I (no lymphovascular invasion, tumour <4 cm). AFP and beta-hCG are normal post-orchidectomy. What is the recommended post-orchidectomy management?

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Correct answer: C — Active surveillance

For stage I seminoma (confined to testis, normal post-orchidectomy markers), active surveillance is the preferred management strategy with cure rates >99%. Surveillance involves regular clinical review, tumour markers, CT imaging, and CXR according to a structured schedule. Relapse rate on surveillance is ~15–20%, and relapsed disease is almost always curable with chemotherapy or radiation. Adjuvant carboplatin (single cycle) or adjuvant radiation are alternatives that reduce relapse to ~4–5% but expose patients to unnecessary treatment toxicity given the excellent cure rates with surveillance plus treatment at relapse.

Reference: Cancer Council Australia – 2019 – Testicular Cancer Guidelines; NCCN – 2025 – Testicular Cancer