How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?

With respect to working up the enlarging lymph node, I agree with @Dr. First Last and @Dr. First Last above. If confident that this is seminoma recurrence, tumor markers normal, and if stage IIA or select stage IIB (select non-bulky, <=3cm) cases, our team advocates for radiation to the para-aortic ...

I generally agree with @Dr. First Last' stance, as is so often the case. That said, in the marker negative setting, I tend to get a biopsy to confirm what I am about to manage -- it could be pure seminoma, it might have transformed or represent a focus of occult NSGCT in the primary (that was missed...

The question is how to manage an enlarging RP node in some with what I assume is histologically proven pure seminoma without nonseminoma elements at orchiectomy with normal classic serum tumor markers.

Typically, I would base the decisions on the size and location of the nodes. For nodal enlargement...

Recurrent seminoma is very curable and there are several approaches that are successful. The addition of adjuvant carbo to radiation makes complete sense and we will be getting more data on this. Also, experience with RPLD was just reported. There can never be an RCT to answer this question. With mu...

We favor radiation therapy for IIA disease and chemo for IIB. That being said, recent SAKK data, once published, may change management to single agent chemo with involved site radiation.

https://www.urotoday.com/conference-highlights/esmo-2021/esmo-2021-testicular-and-penile-cancer/132233-esmo-2021-...