American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the usual treatment for patients with stage I seminoma confined to the testis?

1. Orchiectomy

2. Chemotherapy alone

3. Radiation therapy

4. Active surveillance

The correct answer is: Orchiectomy

The usual treatment for patients with stage I seminoma confined to the testis is an orchiectomy, which involves the surgical removal of the affected testis. This procedure not only serves as a definitive treatment for seminoma but also aids in the accurate staging of the disease and the confirmation of the diagnosis through histopathological examination. Following orchiectomy, patients may be monitored for recurrence, but immediate adjuvant therapy like chemotherapy or radiation is often not required as stage I seminoma has a relatively high cure rate and low overall risk of progression. In some cases, patients may be placed on active surveillance after orchiectomy, particularly if there are no high-risk features, but the primary treatment remains surgery. This approach is guided by clinical evidence suggesting that orchiectomy is effective in managing localized testicular cancer and helps to improve patient outcomes while minimizing unnecessary overtreatment. The other options, such as chemotherapy alone or radiation therapy, are typically considered for advanced stages or high-risk cases, rather than for isolated stage I seminoma, emphasizing the importance of tailoring treatment to the specific stage and characteristics of the cancer.