[Update] Stage I seminoma - Surveillance vs. chemo, I chose surveillance

[u/Successful_Fox8833]

Hey everyone,
Quick update after my oncology appointment with a highly regarded professor in my country (EU). I’m 31 with stage I seminoma (pT2 L1V0 PnI0 R0 15x12x10mm) and after weighing options, I decided on surveillance.

• The professor strongly recommended surveillance, noting newer data about increased long-term cardiovascular risks 15-20+ years after chemotherapy, which matters for us since many TC patients are in their 20s-30s. According to him, a lot of care focuses on the first 5–10 years, but lifetime risks also matter.
• He also discussed management if I relapse in the abdominal lymph nodes. From what I understood, there’s growing support that surgery (RPLND) can be used at relapse rather than defaulting straight to chemo,
• He mentioned that lymph nodes can be temporarily enlarged after orchiectomy alone, which can cause false positives if scanned too early. Because of that, he recommends the first scan at 6 months (not 3 months) to reduce unnecessary anxiety and interventions. Markers every 3 months
• For risk of relapse, I’m including a photo of a new proposed risk model from a 2023 study that I found, and it helped calm my nerves. According to that paper, people with tumors <2 cm and with either LVI or RTI (but not both) are in a lower-risk group, with relapse risk up to around 8%. Link: https://pubmed.ncbi.nlm.nih.gov/37951820/
• It's unlikely that my 2mm microtumor on the lungs is metastasis because markers are normal

Why I chose surveillance:

• Seminoma responds well regardless of initial strategy, surveillance avoids exposing everyone to treatment toxicities when most won’t relapse,
• I don't want to do chemo since I know myself and I don't respond well to a lot of medication, also super scared of side effects, and long-term damage to the remaining testicle
• EAU recommends surveillance even in high risk patients in Seminoma 1 stage, link: https://uroweb.org/guidelines/testicular-cancer/chapter/disease-management

Plan forward:

• Markers every 3 months, ct pelvis+abdomen every 6 months, chest x-ray every 6 months
• I’ll keep monitoring and update if anything changes

I’m sharing this for anyone undecided. I hope the info I found brings a bit more peace with a surveillance decision

Stay strong guys! 💪

UPDATE 11.08.2025:
I don’t plan to just hope for the best - I’m supporting my recovery with diet changes tied to lower cancer risk: plant‑based eating, proven anti-cancer supplements like turmeric, green tea. No processed foods, and intermittent fasting, more stress free living(still struggling lol)

[u/Successful_Fox8833]

Looks like photo didnt attach correctly, here it is. Stage 1 seminoma relapse risk: EAU criteria, 2023
https://imgur.com/a/jQ5LjAG

[u/DryPomegranate8713 → u/Successful_Fox8833]

Thank you for posting. Stage 1b seminoma. I had clean CT scans prior to April 22 orchi, decided to get a second opinion at a leading TC center and had CT scans conducted there May 27. That scan showed a 0.9cm x 0.8cm lymph node on para aorta. Doctor said it could be inflamed from orchi, or could be early metastasis. I’m scheduled for a follow up CT scan on Aug 21. Obv hoping lymph node was just inflamed from orchi, will know soon enough. But it has made for a long summer.

[u/Prefect_99 → u/DryPomegranate8713]

I know it can be hard, but try to put it to the back of your mind.

The die is cast, you can't change the outcome, only wait for it. Worry won't change anything. Have fun, eat well, do what you do and enjoy best 👍

[u/DryPomegranate8713 → u/Prefect_99]

Thanks for your response and I agree whole heartedly. And that’s pretty much what I’ve been doing…trying to enjoy my summer.

[u/Successful_Fox8833 → u/DryPomegranate8713]

I think it is good that ur doc still recommended follow-up CT instead of treatment, seminomas don't spread that fast, so there is always time to do chemo - that's what my doc said. For now you should take a rest and take care of your body, so if there some infection of fluid build up it will go back to normal till next CT