(UroToday.com) The management of stage 2A seminoma has been consistent over the past several years, consisting of either radiotherapy of 30 Gy to the para-aortic and ipsilateral iliac lymph nodes or primary chemotherapy with either three cycles of BEP or four cycles of EP. Cure rates with these approaches are excellent but are also associated with many life years of potential cumulative toxicities. For example, the hazard ratio for cardiac events and secondary malignancy range between 2 and 3 depending on the study. Additionally, there is a risk for bleomycin-induced pulmonary injury, neurotoxicity, and metabolic syndrome. More recently, investigators have been exploring the utility of retroperitoneal lymph node dissection (RPLND) in early metastatic seminoma. This is based on the known effectiveness of RPLND as a primary therapeutic intervention in Stage 1 and 2A non-seminoma, as well as after chemotherapy in both non-seminoma and seminoma. Overall, data suggest lower long-term morbidity with RPLND compared to chemotherapy or radiation therapy. Efficacy data for RPLND as primary management of stage 2A seminoma has been limited.