Metastatic testicular cancer is a curable malignancy with cisplatin based chemotherapy. However, some men develop platinum resistance, and despite high dose chemotherapy die from their disease. Over the last 5 years increased knowledge of the biology behind this phenomenon has led to opportunities for enhancing treatment intensity for this subgroup. On the other hand, population based research has shed light on the ability to place many patients on simple surveillance after orchidectomy and sparing them chemotherapy related side effects. The evidence behind these developments will be reviewed.