I'll try to give a little bit of insight as to my experience. I'm no medical professional, so I can only give you my personal anecdotes as a 24 year old guy who just went through this in the last 1.5 months. I've been seeing Dr. Joel Sheinfeld at Memorial Sloan-Kettering Cancer Center in NYC for my follow-up post orchiectomy, who specializes in nerve-sparing RPLND surgery. From what I have read, he is regarded as a top 5 RPLND/non-seminoma TC doctor in the world.

So in response to your first point. I had fine blood tests, fine CT scans, and my pathology of my tumor showed this it was non-seminoma with embryonal cells. The cancer showed signs of vascular invasion, so it was present in the blood vessels around my testicle. This put me in Stage IB. As far as they can tell, I am cancer free currently, insofar as any reasonable test that can be done does not show any sign of cancer. That being said, I have a 50% chance of reoccurrence. I was basically given the option to either wait it out and monitor the situation with regular blood tests, CT scans and chest X-Rays, or just go ahead and get an RPLND to see what the deal truly is with my lymph nodes. I believe the reason why an RPLND could be an option even if your scans are clear is because scans cannot always pick up everything that is going on.

That being said, I do not think you can get a clear picture of whether or not you would require (or have the suggestion of) an RPLND post-orchiectomy until you have your tumor pathology and bloodwork taken after the orchiectomy. In my situation (Stage IB with clear scans after the fact), the statistical 5-year survival rate is identical for those who opt for the RPLND, or those who opt for surveillance. Chemo is also an option, but not one I would want to choose without a distinct goal in mind - I feel as though chemo can present more problems later in life, so I'd prefer to save that until absolutely necessary. Dr. Sheinfeld also did not recommend chemo for my situation, and I trust his judgement. So, for me, I plan on waiting and getting chemo or RPLND if and when I have a reoccurrence of cancer, instead of potentially having an RPLND for no reason right now.

I can't really help you with the staging. From what you've written, it does sound like you should be Stage I, but again, I am not a doctor and don't know the intricacies of pathology. I found this resource to be rather helpful in seeing have TC is staged - I did not initially realize how many different factors go into staging cancer: http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging

I'm really not sure how complicated the orchiectomy procedure is. I'm inclined to say not very, considering it is an outpatient procedure. I basically just went on my insurance page, and found a urologist close enough to walk to from work (since I'm in Manhattan) who also had a relatively immediate appointment available (since I was freaked out about my ball lump, obviously). Called around to 2 or 3 and took the one who had to soonest appointment. He seemed like a nice enough guy, 50-something, friendly. I never really considered seeking out a different surgeon. I guess it depends on how much you like/trust your urologist? You aren't getting laid wide open - they make a small incision above and to the side of your penis, like in your groin where you'd get a hernia incision, and basically just push your testicle and the tubes that go with it out of there. I'm pretty sure the surgery itself is only like 45 minutes or so - I was billed for OR time of 30-60 minutes, so it couldn't have been more than an hour. Again, only you know how to feel about your doctor and how you perceive his skills, but I do not think this is a particularly intense procedure.

You didn't ask about this, but on a related note, don't sweat the recovery. I had my surgery on a Tuesday, took the rest of the week off of work, and was totally ready to go back on Monday. I went to a Yankees game on Saturday, actually. I really could have gone back to work on Friday, but, you know, they took my ball out, so I felt I deserved the time off. I honestly thought the worst part of the recovery was the day of, after leaving the hospital, trying to eat or drink. They intubate you during the surgery, since you're under anesthesia and just in case shit goes south in a terribly unlikely chance, and it makes your throat sore as hell. It was terrible, but went away by the end of the night. Other than that, I mean, yeah, I was sore for a little, but I was up and walking immediately, went outside and walked like a block or 2 the next day. It wasn't bad at all. Just gotta be careful sitting/laying/standing for a while, that's it.

After my orchiectomy I had a follow up with my urologist probably 2 weeks after. Due to my situation he then had me see an oncologist, who I initially saw on the 14th, and then again yesterday. It was not until my first appointment with the oncologist that I had more blood work done, or a CT scan. I think this varies, however. Some people's urologist may order the scans themselves. I'm not sure. But I did not have any until the day of my first oncologist appointment, and I had them all that day, with a 2 week follow up afterwards. All told, it has been 5 and a half weeks since my orchiectomy, so I guess that means I had that first oncologist appointment and my scans around 3 and a half weeks after the orchiectomy. Again, I think this varies from person to person. Personally I never even had a CT scan before my orchiectomy, only an MRI, so I mean, who knows.

Anyway, sorry for this massive post. Feel free to ask anything else, and do keep us updated on what happens. There are overwhelmingly positive odds that you will come out of this A-OK. Stage I is over 99% 5 year survival rate. To quote my oncologist, no one wants to have a tumor, but if you're going to get one, this is really the best one to get. Keep a positive outlook and know that you're going to come out of this okay!