Abstract
Fertility preservation begins with pretreatment counseling in male oncology patients but may continue well beyond oncologic diagnosis and treatment. Longitudinal follow-up is needed to determine the duration and extent of spermatogenesis impairment in men. When assessing testicular reserve in a male cancer survivor, clinicians should keep in mind that the minimum initial evaluation of the patient should include a full medical history, physical examination, and measurement of serum testosterone and FSH levels. Additionally, semen analysis is currently the gold standard for assessing fertility status in the male. This test is readily available at most tertiary care centers and can be performed at any age after puberty.
Keeping in mind that these tests are not perfect and do not represent ideal biomarkers, research has shifted to developing more sensitive, specific, low-cost, and attainable tests. Looking to the future, as the era of “personalized medicine” progresses, panels of biomarkers that stratify baseline fertility potential and posttreatment infertility risk will further facilitate clinical decision-making for both healthcare providers and their patients.
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Review Questions and Answers
Review Questions and Answers
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Q1.
A comprehensive urologic physical exam should include:
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(a)
Overall appearance, including muscle mass and body hair
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(b)
A breast exam to assess for gynecomastia
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(c)
Testicular exam documenting the size, consistency, and location of the testicles bilaterally
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(d)
Assessment of spermatic cord structures for the presence and condition of the epididymis and vas deferens
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(e)
All of the above.
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(a)
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A1.
(e)
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Q2.
When assessing testicular function, the minimum hormone evaluation should include:
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(a)
FSH and LH
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(b)
LH and Testosterone
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(c)
FSH and Testosterone
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(d)
AMH and Testosterone
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(e)
Inhibin B and Testosterone
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(a)
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A2.
(c)
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Q3.
FSH
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(a)
Is produced in the hypothalamus and acts on testicular Sertoli cells to support spermatogonial proliferation and maturation
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(b)
Is produced in the anterior pituitary and acts on testicular Sertoli cells to support spermatogonial proliferation and maturation
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(c)
Is produced in the hypothalamus and acts on testicular Leydig cells to stimulate testosterone production
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(d)
Is produced in the anterior pituitary and acts on testicular Leydig cells to stimulate testosterone production
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(e)
Is produced in the testicle and acts on Sertoli cells to support spermatogonial proliferation and maturation
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(a)
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A3.
(b)
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Q4.
LH
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(a)
Is produced in the hypothalamus and acts on testicular Sertoli cells to support spermatogonial proliferation and maturation
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(b)
Is produced in the anterior pituitary and acts on testicular Sertoli cells to support spermatogonial proliferation and maturation
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(c)
Is produced in the hypothalamus and acts on testicular Leydig cells to stimulate testosterone production
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(d)
Is produced in the anterior pituitary and acts on testicular Leydig cells to stimulate testosterone production
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(e)
Is produced in the testicle and acts on Sertoli cells to support spermatogonial proliferation and maturation
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(a)
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A4.
(d)
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Q5.
Testosterone is responsible for supporting
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(a)
Muscle mass
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(b)
Hair growth
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(c)
Libido and erections
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(d)
Bone health
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(e)
Red blood cell production
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(f)
All of the above
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(a)
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A5.
(f)
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Kashanian, J.A., Brannigan, R.E. (2019). Assessing Testicular Reserve in the Male Oncology Patient. In: Woodruff, T., Shah, D., Vitek, W. (eds) Textbook of Oncofertility Research and Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-02868-8_16
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