Indawo ye-anatomical ye- prostate gland , ephakathi kwe-millimeters ye-vestile ne-rectum, ithetha ukuba i-urologists ayinakukwazi ukunqumla umgama ojikelezayo. Ukucoca kwi-bladder okanye i-rectum ayikho inketho. Ngelishwa, ukuba umhlaza wesigulane ukhula nge capsule, kunokuba usikelele umhlaza, ugqirha uya kunyanzelwa ukuba aphephe umhlaza xa ezama ukususa ingqungquthela.
Xa oku kwenzekayo kuthiwa "umgama ontle."
Ukushiya umdlavuza emva koko kuyahluleka. Emva koko, ukuba umhlaza awukwazi ukususwa ngokupheleleyo, kutheni usebenza? Inyani le nto kukuba ngaphambi kokuba kusebenze kukho ukuhlala kungaqiniseki malunga nomlinganiselo womhlaza. Ngethuba lokusebenza, isifo esincinci esingaphandle kweprotrath ayibonakali kwiso iso. Khumbula, ubugcisa bokususa iprotratic ukususwa kwaphuhliswa ngethuba elidlulileyo xa zonke i-cancer zibonwa njengosongelo lobomi kunye nokuhlinzwa kwakuyindlela kuphela ekhoyo. Emva koko, iteknoloji ye- radiation yayinqunyiwe. Amanqanaba okunyanga aphantsi kakhulu kunye nemisipha kunye nemiphumo emibi yecala ayingozi.
Ukucinga kwangoku nge- 3T i-MRI ye-multiparametric eyenziwa ngaphambi kokuhlinzwa, ngelixa lingafezekanga, linakho ukuphucula ukucwangcisa ngokubanzi. Ngelishwa, yincinci yamadoda angama-70 000 asebenza ngokuhlinzwa rhoqo ngonyaka ngokufumana iskripthi sokucwangcisa ukucwangcisa ngaphambi kokuba enze umsebenzi.
Ngethemba, le polisi iya kutshintsha.
Ngenxa yeemeko zesitom echazwe ngasentla, umhlaza, ngokuqhelekileyo, ushiywe emzimbeni wesigulane naphi na kwi-10 ukuya kuma-50 ekhulwini kwexesha. Umgama othe ngqo ufika kwingqwalasela yesigulane iintsuku ezimbalwa emva kokusebenza. Emva kokususwa, iprotate ihlaziywa kwibhubhoratri ngumgqirha okhethekileyo obizwa ngokuba ngu-pathologist.
I-prostate ikulungele ukuvavanya kuqala ngokuyibeka kwibhotile yeki ukwenzela ukuba ingqongqele yangaphandle yengubo ihlanganiswe. Emva koko i-gland isetyenziswe ngokukhawuleza ibe yimimandla emicinci kwaye ingqalelo ekhethekileyo ihlawulwe kwingingqi yegland apho umdlavuza ukhona khona. I-pathologist ihlawula ngokugqithiseleyo umgca we-gland ngokuyisebenzisa phantsi kwe-microscope. Ukuba i-tumor iyabonakala "ihlaselwa" ngokubhekiselele kwi-inkin, ithetha ukuba i-scalpel yokugqirha yagqitywa nge-tumor ngexesha lokusebenza, ishiya i-tumor emva komzimba wesigulane.
Ubukho bomgama obunokuthi bube buninzi okanye buncinci ngokuxhomekeke kumlinganiselo weGleason kunye nobukhulu beendlela ezifanelekileyo. Ngaphakathi kwebhodi, umngcipheko ophezulu wesifo somhlaza wesizukulwana esizayo emadodeni aneemida ezintle malunga nama-50 ekhulwini. Nangona kunjalo, xa umgangatho weGleason uphezulu okanye ukuba iindawo ezilungileyo ziphezulu, umngcipheko wokuphindaphinda kwakhona ungasondela kuma-100 ekhulwini.
Unyango olongezelelweyo xa iimpawu ezifanelekileyo zifumaneka
Ukuthatha isigqibo malunga nangonyango olongezelelweyo emva kokuhlinzwa xa iilwimi ezintle zinokuba nzima. Enye inketho kukugcina nje imeko ngelixa ubeka iliso kwizinga le-PSA ngokukhawuleza. Le ndlela ikhangeleka xa iqela leGleason liphantsi kwaye lincinci elisezantsi.
Amadoda asele ekuxoxweni angakuphepha ukusetyenziswa kwecala elichaphazelekayo ngonyango. Kwakhona, kule nkqubela yekhnoloji ekwenzeni ngokukhawuleza, amadoda ahlawule ukunyanga ukunyuka kwe-PSA iminyaka engaphaya komgwaqo inokuthi umkhulu utye kwixesha lophuhliso oluphuculweyo olunobuncitshisi kwaye lusebenza ngakumbi.
Kubantu abagqibayo ukulandela ukujonga, ukubeka iliso lwe-PSA kufuneka kwenziwe ngekhnoloji engabonakaliyo. Emva koko, ukuba iPSA ikhuphuka, unyango lunokuqaliswa kwinqanaba lokuqala, xa i-PSA isaphantsi kwe-0.1. Ukunyanga amazinga ngokugqithiseleyo xa kuqaliswe unyango kwizinga eliphantsi le-PSA.
Xa izigulane zokugqitywa zichanekile, uphando oluninzi lubonisa ukuba i-radiation ngokukhawuleza kwi-prostate fossa iya kunciphisa amazinga okuphindaphinda kwakhona kwaye inokuphucula ukuphucula i-ten years. Nangona kunjalo, ekubeni i-50% kuphela yamadoda iya kuphinda ibuyele, ukulinda ubungqina bokuphakama kwe-PSA ngaphambi kokuba uqalise imisebe yinto engafanelekanga. Ngokuqhelekileyo, inkqubo yokubeka iliso iquka ukujonga i-PSA nganye kwiinyanga ezintathu. I-radiation iqaliswe ukuba iPSA iphakame ngaphezu kwe-0.1 okanye 0.2.
Imitha yonyango yonyango eqhelekileyo yolawulo lwengingqi yokubuyela emva kokuhlinzwa. Nangona i-radiation ihlala isebenza ngokuphumelelayo, inokwenzeka ukuba i-microstoric metastases ngaphandle kweprotate fossa kwenye indawo yomzimba kufuneka iqwalaselwe. I-radiation kwi-fossa yodwa ayiyi kuba yonyango xa isifo sesasazeke. Ngelishwa, ukuzimisela kokugqibela malunga nokuba khona okanye ukungabikho kwemetrostas microscopic akunakuqiniseka. Akukho teknoloji ithola ngokuthe tye izifo ezincinci kunye neepesenti eziyi-100 ngokuchanekileyo.
Abafundi abanolwazi baye bafunda ngamava ukuba i-metrosase i-microscopic iyakwazi ukuba khona xa umlinganiselo weGleason uphakeme kwaye xa iindawo eziphambili zokucoca ziphezulu. Kule meko, intsimi ye-radiation kufuneka isandiswe ukuze ikhusele i-lymph nodes. I-hormone yokwelapha neLupron iphinda ikhuthazwe.
Iimpawu ezintle ezintle
Ukujongana nomhlaza wesibeletho ngaphandle kokunyangwa ngokukhawulezileyo akufanelekanga kubantu abanamathuba amaninzi afanelekileyo. Amanqatha amaninzi athetha ukuba umhlaza wesiqhelo wawukhulu kwaye uphezulu. Inkqubo yokongamela kule meko ayifanelekanga kuba iidlingozi ezinomdla ziza kuphinda zibuye zibuye zenzeke ngenye indlela. Ukulahla unyango kuvumela ixesha elide lomhlaza ukuba ukhule kwaye usasaze.
Amadoda anamaqela amaninzi afanelekileyo emva kokuhlinzwa kufuneka alawulwe ngendlela yokwelapha i-multimodality ebandakanya i-radiation, unyango lwe-hormone mhlawumbi kunye ne-chemotherapy. Ngokuyinene, lixesha lokwenza ubugwenxa, umzamo wokugqibela wokuphilisa eso sifo. Kukho ukwanda okukhulu phakathi kweengcali malunga neprotocol echanekileyo yokucetyiswa. Nangona kunjalo, ngokubanzi, iinkqubo zonyango zivame ukulinganisa indlela enobungozi obuphezulu, izifo ezisanda kufunyanwa zilawulwa (jonga ngezantsi). Iiprogram zophando nazo zikhangele ukongezwa kwamagunya e-hormone anamandla anjenge-Xtandi okanye i-Zytiga okanye ukongeza kwimijikelezo ye-chemotherapy engu-4 ukuya kwe-6 kunye ne-Taxotere ukubona ukuba amazinga okunyanga angaphunyezwa.
Ingqiqo enhle yokulinda iinyanga ezimbalwa emva kokusebenza ngaphambi kokuqala unyango. Oku kunika ixesha lokuphulukisa kwaye ngokuqinisekileyo liya kuvumela ukubuyiswa kolawulo lwe-urinary ngaphambi kokuqala unyango. Ukulibaziseka okuqhubekayo, kwithemba lokuba umsebenzi we-erectile uya kuqhubeka, inkqubo efuna ukufikelela kwiminyaka emibini, ayisoloko ilumkileyo. Kucinga ukuba akukho ziphumo ezintle ezingalindelekanga, unyango lwe-hormone kunye neLupron kunye neCasodex luqaliswe kwaye luqhubeka kwiinyanga ezili-12-18. Ukubonisana kunye namava olwaphulo lwe-radiation, umntu onamava ekuphatheni i-lymph nodes ye-pelvic, ifunyenwe.
Iingcebiso eziqhelekileyo kumadoda aneemida ezininzi ezifanelekileyo, kukuqala unyango lwe-radiation olujoliswe kwiprotate fossa kunye ne-pelvic nodes. Amanqabana e-pelvic aqala ukuxhuma kwinqanaba lomhlaza ukuba uya ku sasaza. Imisebe iqala malunga neentsuku ezingama-60 emva kokuqaliswa kweLupron neCasodex. (I-hormone therapy inxulumene nenani leminye imiphumo emibi, ezinye zazo zinganciphisa kunye neyeza, ukutya kunye nokuzilolonga.) Ndiyacetyiswa ukuba bonke abantu bacinga ukufunda incwadi endiyibhalile kule sihloko.
Emva kokugqitywa kwemitha kunye ne-hormone therapy, kufuneka uhlolisiso oluqhubekayo. Izinga likaTesttosterone kunye ne-PSA zijongwa rhoqo emva kweenyanga ezintathu ukuya kwiminyaka emibini, emva kweenyanga ezintandathu ukuya kwiminyaka emithathu ezayo. Ukubeka iliso lweTesttosterone kungavama ukuba amanqanaba aqhelekileyo abuyele. Bonke abantu abaye bafumana i-radiation, kuquka nabo baphilisiwe, baya kufuna ukubeka iliso rhoqo ngonyaka ngenxa yengozi yezicathulo zesibini ezibangelwa yimitha ye-bladder okanye i-rectum. Nangona ezi ntlobo zeentlungu zingabonakali, ukufumanisa kwangaphambili kukhokelela kwiphilisi engaphantsi, enyango.