Treatment options in patients with stage I testicular seminoma include adjuvant radiotherapy (RT), surveillance, and adjuvant chemotherapy. RT was the treatment of choice for the past 50 years, but there has been increasing concern in the past decade regarding late complications. Surveillance, reserving treatment for patients who relapse, has been shown to be a safe and effective strategy. It allows >80% of patients to avoid any post-orchidectomy treatment and is the recommended approach for these patients. The possible role of adjuvant chemotherapy is currently being assessed in clinical trials and should not be used outside of a study setting.