Unyaka wonke i-15,000 i-urologists ezivela kwihlabathi lonke liya kwiintlanganiso zonyaka we-American Urology Association (AUA) ukuba zibonise iziphumo zabo zakutshanje zophando lwezokwelapha zize zihlanganyele ngokuphambili kwindlela yokuphathwa komhlaza wesibeletho. Isiganeko sikaMeyi 2017 sibonakalise inkqubela phambili ekuqhubeni iindlela eziye zenziwa kwi-12-core nucleomal needle biopsy yeprostate.
Apha, siza kuxubusha ezimbini kwezi ndlela ezintsha-uvavanyo lwegazi lwe-OPKO 4k kunye ne-3T ye-MRI multi-parameter (MP-MRI). Bobabini banciphise ngokufanelekileyo imfuno yokusebenzisa i-biopsy ye-12 engundoqo.
Amadoda angaphezu kwesigidi aya kwi-12-core core random biop year. Le nkqubo ikhokelela kwizifo ezinzulu, ukungabi namandla, kunye nezinye iingxaki. Okubaluleke kunabo bonke, kubangela ukuxilongwa okungadingekile komdlavuza wesibeletho seBakala 6 ngamadoda angaphezu kwe-100 000 ngonyaka; kwiminyaka eyi-10 edluleyo, iingcali zifumene ukuba iBakala 6 akufanele libheke njengomdlavuza kwindawo yokuqala , njengoko ingenakho imitha esetyenziswayo. Nangona kunjalo, emva kokufunyaniswa ukuba neBanga 6-phantse njalo ngenxa yesigxina se-12-engundoqo ye-biopsy-up of 50,000 amadoda minyaka yonke iqhutyelwa ukuhlinzwa ngokugqithiseleyo okanye i-radiation ukuphatha le meko engenakonakalisa. Kulula ukubona ukuba kutheni ezinye iindlela eziza ku-12-core biopsy zinenzuzo kwaye zinomdla.
Iinzuzo zovavanyo olulula lwegazi
Kwintetho kwi-2017 AUA, uDkt. Stephen Freedland waseCedars yaseSinayi eLos Angeles uxoxe ngekhono lovavanyo lwegazi lwe-OPKO 4K ukuchaza kwangaphambili umdlavuza weprotate (CSC). Oku kuchazwa njenge- Gleason 7 okanye ngaphezulu komdlavuza wesibeletho , uhlobo lomhlaza womhlaza wesifo omele unyango.
Yena kunye nabaphengululi bakhe baqhathanisa uvavanyo lwe-OPKO kwi-PSA algorithm ephakanyisiweyo eyenziwa ngamanye amanqaku ebalulekileyo okuqikelela okufana nesimo somguli kunye novavanyo lwama-rectal.
Ulingo olubandakanya amadoda angama-366 kunye novavanyo lwe-OPKO lwabonakaliswa ukuze kuphunyezwe ukuphuculwa kokubaluleka kokuchaneka kwi-algorithm ye-PSA yokuqikelela i-CSC. Uvavanyo lufunyenwe luchanile kumadoda ase-Afrika aseMerika (abantu abanomdla we-prostate). Ekubeni luvavanyo lwegazi olulula, i-OPKO yinqanaba lokuqala lokujonga ukuhlolwa kwabantu abangenawo amadoda angama- PSA amanqanaba angaphezu kwebala eliqhelekileyo leminyaka yabo.
Ukuqhubela phambili kwi-Prostate Imaging
Ngokomlando, i-prostate scans yayingenakulungile. Okwangoku, ukuskena kutsha kakhulu ukuba ukuxilongwa komhlaza wesifo se-prostate kusencike kakhulu kwi-12-core biomal biopsy. Kungenxa yoko ukucinga ngenye yezona ndawo zifudumele kakhulu kwaye zikhula ngokukhawuleza zophando lomhlaza wesibeletho.
Kukho imiba emininzi yokuguqula ukucinga ngeMMP multi-parameter (MP-MRI):
- I-MP-MRI, kunokuba i-biopsy engahleliyo, ingaba yindlela yokuqala yokuxilonga. Iskripthi esaqulunqwa ngaphambili kwinqanaba lokugqwesa lichaneke ngakumbi kunokwenza i-biopsy engahleliyo yokufumanisa umdlavuza wesibeletho esibalulekileyo.
- Ukuba ukukhangela kubona okungaqhelekanga, i-biopsies yealiti inokuqondiswa ngqo kwi-tumor enokuthi isebenzise inani elincinci le-biopsies ejoliswe kuyo. Ukuba umhlaza ukhona, ulwazi malunga nebanga leGleason lichanile ngakumbi.
- Ukuzimisela kwinqanaba lomhlaza lichaneke ngakumbi. Ngokomzekelo, ukuhlasela kwesi sifo sesifo somhlaza (ngaphandle kwe-gland) kulula ukuyijonga yi-MP-MRI kunokuba ne-biopsy engahleliyo.
- Amadoda anomdlavuza omgangatho ophantsi, oye wagqiba ukubeka iliso kwimeko yawo ngokubhekisisa, usetyenzise enye indlela yokusebenzisa i-MP-MRI kunokuba wenze i-12-core core random biopsies rhoqo.
Enye yeyona nto ibaluleke kakhulu kwintsimi ye-prostate imaging kuye kwaba kukuphuhliswa kwenkqubo yokufanisa ukulinganisa amabala angavamile (okunye kwaziwa ngokuba "izilonda"). Eyona nto ibonakalayo, ingxelo yeProstate Imaging Reporting kunye neNkqubo yeDatha (i-PI-RADS), iibakala zezilonda kwizinga elilodwa ukuya kwezihlanu. Izigulane kufuneka ziqonde ukuba le nkqubo intsha, kwaye oogqirha abafunda ezi ziko bafunda ukusetyenziswa kwe-PI-RADS kwintsebenzo enkulu kakhulu.
Oogqirha uPeter Pinto noPeter Choyke beSizwe seCancercer Institute babike ngokuchaneka kwe-PI-RADS ukufumana umdlavuza we-prostate ophawulekayo (CSC), ophinde wachazwa njengeGleason 7 okanye ngaphezulu. Bavavanya izigulane ezingama-339 ezenza i-MP-MRI. Izilonda ezingavumelekanga zavandlakanywa ngokuqhuba i-biopsy ejoliswe kuyo. Xa izilonda ze-PI-RADS ezingama-5 zazixilongwa, i-CSC yafunyanwa i-72 ekhulwini yexesha. Nangona kunjalo, iipesenti ezingama-22 kuphela zeepI-RADS ezine zilonda, iipesenti ezili-12 ze-PI-RADS izilonda ezi-3 kunye neepesenti ezili-10 ze-PI-RADS 2 izilonda zibonisa i-CSC.
Ngokusekelwe kule ngcaciso efunyenwe kwiziko eliphambili lokugqwesa, kubonakala kunengqiqo ukuqwalasela ukwenza i-biopsy ejoliswe kumadoda ane-PI-RADS 4 ne-5 zilonda kunye nokujonga nje amadoda ngokuphinda i-MP-MRI kwiinyanga ezili-6 ukuya kwezi-12 ukuba i-PI -I-RADS 1, 2, okanye i-3 lesion ifunyenwe.
Zichanekile Njani Ezi Zingxelo?
Ngokwe-uphando olongezelelweyo kwinkqubo ye-PI-RADS yokufunda i-MP-MRI, eyabhalwa nguDkt. Gerald Andriole nabanye, isabelo esifanelekileyo samanqaku e-PI-RADS ngama-radiologists aqeqeshiwe sifuna i talente engenanto, kungekhona nje ngamava. Iziphumo ezichanekileyo azixhomekeke kumava amaninzi ngokufunda izicatshulwa. Kulo pho nonongo, abaphandi bajonga ukuchaneka kwe-PI-RADS yokufundwa kwii-radiologists ezine zamava ahlukeneyo kwaye bafumanisa ukuba ukuchaneka akuzange kuphuculwe ngamava amaninzi.
Kule sifundo, i-biopsy ekujoliswe kuyo yayisetyenziselwa ukulinganisa ukuchaneka xa i-radiologist yabela i-PI-RADS level 4 okanye 5 lesion, nokuba i-biopsy ibonise isiqendu se-Gleason se-7 okanye ngaphezulu. Kulo cwaningo, imifanekiso yezi zi gulane zachongwa kwaye yalayishwa yinkampani yesithathu eyimfama. Ngenxa yoko, ii-radiologists, zichaze zonke i-prostitutes MRIs ngokuzimela. Ukufunda "okuphosakeleyo" kuye kwachazwa njengesabelo sePI-RADS 4 okanye 5 nge-biopsy yokulandelelana ebonisa uGleason 6, okanye akukho mhlaza. Omnye "ukuphosakeka" ukufunda kwakukwabiwa kwe-PI-RADS 1, 2 okanye 3 xa umphumo we-biopsy wayenguGleason 7 okanye ngaphezulu.
Ukuchaneka kokufundwa kwegqirha kuye kwavela kuma-56 ukuya kuma-75 ekhulwini kunye nokufumanisa okuchanekileyo akuzange kuhambelane nobude bamava okufunda i-MP-MRI. Ngoko, oko kuthetha ukuthini isigulane? Kwaye kwavela ukuba ukuhlanganiswa kweenguqu ezivela kuzo zonke ii-radiologists ezine zinike iziphumo ezichanekileyo. Oku kubonisa ukuba ukuchazwa ngokuvisisana kwe-prostate i-MRI ingaba yindlela yokuphucula ukuchaneka kwangaphambili.
Iyiphi Impembelelo IiNqanaba zeTesttosterone ezinezicwangciso?
Ngoku ukuba i- MP-MRI iyanda ekuthandeni, omnye umbuzo obalulekileyo uvele, "Amazinga aphantsi e-testosterone afaka njani ukuchaneka kwee-MP-MRI?" Le ngxaki ebalulekileyo. Njengoko amadoda ekhula, amanqanaba e testosterone ahlala ehla. Ekubeni ukwehlisa i-testosterone kuyaziwa ngokuba nefuthe le-antiticancer, amazinga athile aphantsi kwe testosterone angathinteka njani i-MP-MRI?
Olunye uphando, oluvela kwiNational Cancer Institute, lwahlalutya izigulane ezingama-522 ze-hypogonadal. I-PSA yabo yangaphakathi yayingu-6.66 kunye ne-testosterone yamanqaku yayingu-171. La madoda angama-522 afaniswa nomnye, iqela elikhulu lamadoda anesifo se testosterone sasi-311. Kuyavela ukuba iziphumo zengcamango phakathi kwamaqela amabini zazifana, nangona kwakukho ngaphantsi izinga lokufumana umhlaza wesifo somzimba kwi-hypogonadal amadoda (iipesenti ezingama-28.8 nama-37 ekhulwini). Nangona kunjalo, amazinga okufumanisa xa i-biopsy ejoliswe kuyo yayifanayo (iipesenti ezingama-40.4 kunye neepesenti ezingama-43.6).
Kwama-522 amadoda, 78 aqhutyelwa unyango. Iingxelo zokugqibela zengqondo kwezi zigulane ezingama-78, (xa kuthelekiswa nelinye iqela lamadoda aphethwe yi-testosterone eqhelekileyo), yabonisa izinga eliphezulu lokuphucula amanqaku (iipesenti ezingama-22.2 kunye neepesenti eziyi-12.5), ukuhlasela kwe-vesical rhoqo (rhoqo kwi-11.1% vs 6.0 ipesenti) kunye nokuhlaselwa kwe-lymph node ephindaphindiweyo (iipesenti ezili-11.1 malunga neepesenti ezingama-7.5). Ngokusekelwe kwezi ziphumo zophando, amanqanaba aphantsi e-testosterone kufuneka enze ukuba oogqirha babe yincwadana encinci yezinto ezifunyenweyo ezichazwe kwi-MP-MRI.
Olunye uphando oluvela kwiYunivesithi yaseCalifornia, iSan Francisco livavanya indlela kakuhle ngayo i-PI-RADS esichazela ukufumana izifo emva kokuhlinzwa (mhlawumbi kumadoda ane testosterone eqhelekileyo). Kule ngxelo yezigulane ezili-121, abaphandi bajonga indlela i-PI-RADS eqikelele ngayo ukuba kwenzeke ukuba kubekho umgangatho ophezulu weGleason (4 + 3 = 7 okanye ngaphezulu) okanye ukusasazeka komhlaza ngaphandle kwe-capsule ye-prostate gland. I-MP-MRI phambi kokuhlinzwa, yabonisa ukuba ezingama-69 zezigulane ezingama-73 ezinezifo ezinokukhubazeka zinokuba zi-PI-RADS 4 okanye 5. Ngoxa ababhali bephelile ukuba amanqaku ama-PI-RADS angama-4 okanye ama-5 ayaba nexhala kakhulu ekufumaneni nasekuchazweni i-pathology, i-PI-RADS 4 okanye i-5 ngaphezulu-iqikelela ukuba i-pathology engalunganga kwinqanaba elithile. Ngokomzekelo, kuwo onke amadoda anama-PI-RADS 4 okanye ama-5 ngaphambi kokuhlinzwa, i-sibini kuphela yesithathu yabonakala ibe ne-pathology engalunganga.
I-MP-MRI inikezela ngenzuzo enkulu kwi- 12-core core random biopsy yamadoda ngokubhekiselele-indlela ekhethiweyo yokulawula umhlaza wesibeletho seBakala 6. Uphando lwangoku luye lwagqiba ukuba iBanga 6 alikho i-metastatic potential. Ngamanye amazwi, ayikwazi ukusasazeka kwaye akusiyo umhlaza. Ukuqwalasela okusebenzayo kwenza amadoda akhuphe ngokukhawuleza ukuhlinzwa okanye imisebe emininzi iminyaka.
Ukuqwalasela ngokunyanisekileyo kunye neBakala 6 yeCarstate Cancer
Ukuba kuyinyaniso ukuba amadoda ekuqwalaselweni kokuqwalasela okungafanelekanga akufanele akhathazeke ngeBakala 6, ukukhathazeka ngokwenene kukubakho ukugcina ibakala lesi-7 okanye umhlaza ophezulu ongaphoswanga yi-biopsy yokuqala. Uphononongo lubonisa ukuba i-biopsy engahleliyo ilahlekelwa izifo eziphezulu eziphezulu kweepesenti ezingama-25 zexesha. Uphando oluvela kwi-UCSF, olukhankanywe ngasentla, luchaze ukuba i-MP-MRI ibona iGleason 4 + 3 = 7 okanye ngaphezulu kwama-95 ekhulwini. Ngokucacileyo, olu cwaningo lugxininisa ukuba amadoda aphethe iGleason 6 abecinga ukujonga iliso kufuneka abe ne-MP-MRI ukuqinisekisa ukuba akukho CSC ephosakelwa yi-biopsy.
Kwesinye isifundo, iqela loogqirha esekelwe ku-Ann Arbor, eMichigan kwakhona lijongene nombandela wokwenza i-MP-MRI kumadoda aphinda ahlolisise. Baye baphinda bahlaziywa ngamadoda angama-225, 209 kunye no-Gleason 3 + 3 = 6 kunye no-16 kunye no-Gleason 3 + 4 = 7. Bonke babephantsi kwe-MP-MRI elandelwa yi-biopsy ekujoliswe kuyo ukuba kukho i-lesion. Iziphumo zibonise ukuba ngaphandle kokungena kwi-MP-MRI, izigulane ezili-12 ezinezikolo eziphezulu ziza kubanjelwa kwaye ziza kufakwa ngokungafanelekanga ekuhlolweni. I-biopsy ejoliswe kuyo ibonisa ukuphucula amanqaku eGleason kuGleason 4 + 3 = 7 kwizigulane ezimbini, ukuya eGleason 4 + 4 = 8 kwizigulane ezingama-9 kunye no-Gleason 4 + 5 = 9 kwisigulane esinye.
ILizwi
I-biopsy engama-12 engundoqo, eyaqala ukuqala ngasekupheleni kweminyaka yee-1980, yayisinye indlela, yodwa indlela yokufumanisa umdlavuza weprotate. Nangona kunjalo, ngoku siyazi ukuba unyaka ngamnye amadoda angaphezu kwe-100 000 anesifo esiyingozi ebangeni lesi-6 afunyaniswa nge-biopsy engahleliyo. Olu xilongo lubangela unyango olungadingekile kuma-50,000 amadoda ngonyaka. Kuze sifunde indlela yokucima isigama sesiganeko esikhathazayo esihambelana neBanga lesi-6, ukukhusela okusemgangathweni kukukhusela i-biopsy ngokulandelelanayo. Amadoda anamazinga aphakamileyo ePSA kufuneka acinge ukuba enze uvavanyo lwegazi lwe-OPKO 4K. Ukuba iziphumo zokuvavanya zibonisa ukuba umngcipheko wesifo esiphezulu siphezulu ngaphezu kweepesenti ezili-10, i-MP-MRI kwiziko lokugqwesa iya kuba yinyathelo elilandelayo elifanelekileyo.
> Imithombo:
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