OnExamination PLAB 1 (Updated Feb 2023) (PDF)

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Demo Question: A 22-year-old man is diagnosed with acute lymphoblastic leukemia and as a part of his treatment, a testicular radiation therapy is planned. The man is concerned about the effect of this treatment on his future fertility. Which of the following options is the best course of action in this case?

• Changing the treatment regimen
• GnRH replacement
• Reassurance
• Sperm banking before treatment
• Testosterone replacement after treatment

Key Learning Point: Chemo- and radiotherapy are very important causes of future infertility, and this issue should be addressed before starting therapy.

Explanation: This is one of the most contentious issues in cancer therapy. The topic should be discussed at length with the patient (male or female) before initiation of therapy. Ideally, the discussion should involve oncologists, nurses, psychologists, and other technical personnel as necessary.

In males, sperm cryopreservation is the only fertility preservation method. The sperms should be collected before starting chemo/radiation therapy. It should be emphasized that once therapy has started, there is a high risk of genetic mutation and other damage to the sperms, so it is imperative that the issue be raised before any therapy is initiated.

Hormone replacement therapy has not been found to be effective as a fertility preservation method. Various studies have shown that concerns about fertility are a very important issue for cancer patients, but in some cases, the issue is not raised in time.