Despite optimal radiation field is still being discussed, the traditional treatment for patients with low-stage seminoma of the testis has been orchiectomy followed by externalbeam radiation therapy. The other treatment modalities are adjuvant radiation therapy and/or chemotherapy. We sought to identify the best treatment option in patients with low stage pure seminoma following orchiectomy. From 1994 to 2004, 34 patients with clinical stage I seminoma were placed on surveillance policy following orchiectomy in our hospital. After a median follow-up of 24 months, relapse was observed in seven patients. The sites of relapse were retroperitoneal lymph nodes in seven patients and isolated lung metastases in one patient. According to their stages; five of the relapsing patients were treated with radiotherapy and 2 patients received chemotherapy. A contralateral testicular tumor developed in one patient and inguinal orchiectomy was performed. None of the patients have had a second relapse or died from his disease due to therapy. Though, surveillance is a good option for the patients with stage I testicular seminoma, we do not advocate this policy according to the following reasons; 1- A longer period of intensive follow-up is required, 2- The time to relapse in stage I seminoma is not only longer than that of nonseminomatous testis tumors, also relapse rates are almost 50% lower, 3- The higher progression rate compared with irradiated patients, 4- The awareness of having a tumoral disease with the accompanying uncertainty about the future may be stressful to the patient, 5- The necessity of a metaanalysis to define more accurate risk factors. The routine management of low-stage pure testicular seminoma should be radiotherapy following orchiectomy. [Turk J Cancer 2006;36(4):169-175].