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A 28-year-old man presents to the clinic complaining of heaviness in his testicle for 2 weeks. He says he feels as though his testicle is enlarged. The man has a temperature of 37.2°C (98.9°F), heart rate of 60/min, and blood pressure of 115/70 mm Hg. He has a normal abdominal examination with no palpable masses. The right testicle is noticeably larger than the left testicle. There are no discrete nodules. Testicular ultrasound is performed, followed by an orchiectomy. He is found to have a seminoma and a retroperitoneal lymph node that is enlarged at 1.8 cm. He is given a diagnosis of stage IIA testicular seminoma (T2N1M0).
What additional treatment is needed?
A. Contralateral orchiectomy
B. Platinum-based chemotherapy and bilateral orchiectomy
C. Prophylactic mediastinal radiation
D. Retroperitoneal lymph node dissection
E. Retroperitoneal radiation
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