NEWFlashcards for any set of questions, quick-reference tables for breast, lung and prostate, and a month of access for every colleague you refer. See what changed

Urology: Stage I seminoma management

Free question published 25 September 2026

UrologyStage I seminoma management

A 34-year-old man has undergone radical inguinal orchidectomy for a 3 cm pure seminoma. Staging CT is clear and post-orchidectomy tumour markers have normalised, confirming clinical stage I disease. He is reliable and willing to attend follow-up. Which adjuvant strategy should NOT be offered as routine?

  1. AAdjuvant para-aortic radiotherapy
  2. BActive surveillance
  3. COne course of adjuvant carboplatin AUC 7
  4. DDiscussion of surveillance versus single-dose carboplatin based on patient preference
  5. EConsideration of tumour size as a risk factor when counselling

Why A is correct

ESMO-EURACAN guidance and supporting evidence indicate that adjuvant radiotherapy is no longer routinely recommended for stage I seminoma because of the high risk of radiation-associated second malignancies and cardiovascular morbidity. Surveillance is the preferred option, with one course of carboplatin AUC 7 (non-inferior to radiotherapy in MRC TE19) as the adjuvant alternative.

And why the others are not

  • BIncorrect (this is appropriate): active surveillance is the preferred management for stage I seminoma.
  • CIncorrect (this is appropriate): one course of carboplatin AUC 7 is the standard adjuvant chemotherapy option.
  • DIncorrect (this is appropriate): shared decision-making between surveillance and single-dose carboplatin is recommended.
  • EIncorrect (this is appropriate): tumour size is a recognised weak risk factor used in counselling higher-risk patients.

Source ESMO-EURACAN — Testicular seminoma and non-seminoma Clinical Practice Guideline — Oldenburg J, Berney DM, Bokemeyer C, et al. Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022;33(4):362-375. Open-access supporting review: Treatment options in stage I seminoma, PMC10208057.

More free urology questions

Sitting in February? Follow the twenty-week plan.

2,500+ cited questions like this one are waiting in the vault.

See plans and pricing