Active surveillance is appropriate for this patient with stage I seminoma following resection. Testicular germ cell tumors are divided into pure seminomas and nonseminomatous germ cell tumors (NSGCT). Recommended postsurgical treatments vary based on histologic findings and tumor stage. In general, pure seminoma is associated with a better prognosis than NSGCT. For men with stage I seminoma (disease confined to the testis), radical inguinal orchiectomy is curative in at least 80% of patients. This high cure rate with initial surgical treatment coupled with the ability to treat recurrent disease with curative intent makes active surveillance the lowest-risk approach with an expected good outcome. Active surveillance refers to a regimen of regular assessment with serum tumor marker measurement, CT scans of the abdomen and pelvis, and chest radiographic imaging. As this requires close and regular monitoring, it requires a reliable and motivated patient to be successful.

Other management options after surgery include adjuvant therapy with either single-agent carboplatin or para-aortic lymph node irradiation, although neither approach has been shown to improve overall survival. In addition, neither of these alternatives appears superior to the other, but they might be reasonable to consider in patients who wish to decline active surveillance.

Hematopoietic stem cell transplantation is used for treatment of patients with recurrent or refractory disease, usually only after treatment with multiple chemotherapeutic agents, in selected patients following adjuvant chemotherapy.

Platinum-based chemotherapy (specifically the combination of bleomycin, etoposide, and cisplatin) is the standard regimen for patients with more advanced seminoma, as well as for those with NSGCT. This regimen is not recommended for patients with stage I seminoma because of their very good prognosis and the significant potential for side effects associated with these drugs.

Retroperitoneal lymph node dissection is often used in the treatment of NSGCT but has no role in the treatment of patients with stage I seminoma.