Kukho imithintelo emininzi yokufikelela ekunyamekelweni kakuhle komdlavuza wesibeletho . Okokuqala, njengoko siza kubona ekupheleni kweli nqaku, umdlavuza weprotate unzima, oko kuthetha ukuba ukufumana unyango olufanelekileyo kunokuba nzima. Okwesibini, inani elingapheliyo lenkcazelo engafaniyo kunye nolusemva kwexesha kwi-intanethi lunzima kwaye aluxanduva. Oogqirha , makungabikho izigulane, zixakeke.
Okwesithathu, ixesha lobudlelwane phakathi kwezigulane kunye noogqirha ngokuqhubekayo behla ngenxa yokwanda kwoshishini elikhulu kunye noorhulumente kwiinkonzo zonyango. Ngaphezulu kwezi ngxaki, khawucinge ukuba phantse akukho noogqirha abazikhethela ukhetho lwezokwelapha. Bayazikhethela kuphela kwiingcingo okanye i-radiation, ngoko inkqubo yokwenza izigqibo ishiywe kwisigulane.
Ngaba izigulane kufuneka zijongene nokukhetha iSicwangciso soTyango?
Oogqirha abakhathalela izigulane ze-prostate zegulane banomdla kwimida echazwe ngasentla. Kwaye bayaqonda ukuba kukho ezinye iingxaki. Eyokuqala kukuba oogqirha baneengxabano ezinkulu. Zihlawulwa ukuba zenze uhlobo olulodwa lonyango, utyando okanye i-radiation . Ngenxa yoko, abaxhamli ukunika iingcebiso zonyango. Zingaphi izigulane eziva kugqirha wazo, "Umele ube ngulowo ogqibayo"?
Okwesibini, ukuxela ukuba umgudu wesigulane unobungozi obuthathaka kakhulu ngumhlaza womhlaza wesifo somhlaza wesifo somhlaza wesisu.
Kuthatha iminyaka elishumi kwimpembelelo yesigqibo sokonyango esingazaliseka. Iziprofeto zithe zaphazamiseka ngeprofati esebekhulile yezigulane zomhlaza wesibeletho. Ukufa ukusuka ekuguga kudla kuba ngumngcipheko omkhulu kunomhlaza ngokwawo. Ekugqibeleni, kumongo wale mhlaza, okhulayo okhulayo, impembelelo yonyango kwi-quality-life-things-like impotence okanye incontinence-ingaba mkhulu kunefuthe lokusinda.
Ubani ongcono ukubeka ukulinganisela izinto eziphambili zobomi kunye nokusinda kunokuba isiguli?
Ukwazi isigaba sakho
Ukuthatha inxaxheba kwinkqubo yokukhetha unyango ke akunakukhuselwa kwizigulane zomhlaza wesibeletho. Ukukhethwa kwonyango kubhekiselele kwisigaba somhlaza, ubudala bomdla kunye neenjongo zakhe zobomi. Ngenxa yoko, ukwazi isigaba somhlaza kubalulekile:
- Iyanciphisa inani leendlela zokwelapha kwaye igwema isidingo sokuhlutha inani elininzi lolwazi olungabalulekanga.
- Iphucula ukunxibelelana nodokotela. Oogqirha banokudumka kwiinkcazo ezisisiseko malunga nesigaba kwaye bagxume ngqo kwingxoxo ethelekisayo malunga neyeza esetyenziswa ngokuqhelekileyo kwisigaba esithile sithile.
- Yona ndlela efanelekileyo yokufumana ingcamango enobungozi yomdlavuza kunye nokuphuthuma (okanye ukungabi naso) kwonyango olungakumbi (jonga ngezantsi).
Amanqanaba amahlanu eBlue
Kukho izigaba ezinhlanu eziphezulu zomhlaza wesifo seprotate- I- Sky, Teal, i-Azure, i-Indigo, iRoyal- yeach-containing containing subtypes ebizwa nge- Low, Basic and High , kuba ngama-15 amanqanaba. Izigaba ezithathu zokuqala, izulu, i-Teal, ne- Azure , zifana nezigaba ezinobungozi ezisemgangathweni zezifo ezisezantsi, eziPhakathi, kunye neZingozi eziphezulu eziphuhliswe ngu-Anthony D'Amico waseHarvard Medical School.
I-Indigo neRoyal imela umhlaza wesibeletho obuye wabuya uye waphambili , ngokulandelanayo. Kukho ezinye iisistimu zee-staging, kodwa zonke ziphosakele. Kuphela iiNqanaba zeBlue zimela umbala opheleleyo we-prostate umdlavuza.
Umngcipheko Wokufa KwiCarstate Cancer
Enye yezona zinzuzo ezikhulu kunokuba zibone ukuqonda okukhulu kwesi sifo, esinye sesona sibaluleke kakhulu ekuqaliseni unyango olufanelekileyo. Ukunyameka kwonyango kufuneka kuhambisane nentshukumo yesifo. Iidumbu ezinomhlaza zifanelwe unyango oluncinci. Amanqamana ahlaseleyo afuna unyango olunefuthe.
Iziphumo ezichaphazelekayo zonyango ezihambelana nonyango azivunyelwanga ukuba umhlaza unomnene, kanti ezinye iziphumo zecala ziya kwamkelwa xa kukho izifo ezisongela ubomi. Itheyibhile 1 ibonisa ukuba umngcipheko wokufa uhluka phakathi kwamanqanaba.
Itheyibhile 1: Ingozi yokufa ngeSigaba
Isigaba seBlue | I-Degree of Treatment Intensity Ikhuthazwe | Ingozi yokufa | % yeNew-Diagnated ngasinye kwisigaba |
Izulu | Akukho | <1% | 50% |
Utywala | Eyona ndlela | 2% | 30% |
I-Azure | Ephezulu | 5% | 10% |
Indigo | Mod. KuMax. | <50% | 0% |
Royal | Ephezulu | > 50% | 10% |
Inqaku elibalulekileyo: Itheyibhile engenhla ibonisa ukuba iqondo lokunyanga lonyango linconywe ama-80 ekhulwini lamadoda asandul 'ukufumana unyango (i- Sky kunye neTeal ) ingamodareyitha okanye ayikho.
Isikhathi sokufa kweNtsholongwane yeCrostate
Umhlaza wesifo seprotate uziphatha ngokungafaniyo nezinye i-kansa, ngokukodwa kwindlela ekhula ngayo. Ngokomzekelo, ukufa komdlavuza wamaphaphu okanye umdlavuza we-pancreatic ungenzeka kunyaka wokuqala wokuxilongwa. Ukuqhelana kwethu neentlobo ezibi zesifo somhlaza kuchaza ukuba kutheni igama elithi "umhlaza" lenza ukuba kunzima kakhulu. I-Cancer, sicinga, ilingana nokufa okukufutshane. Kodwa jonga ukuba iinkalo zobume kwiTable 2 zibonisa njani ukuba umhlaza wesibeletho uziphatha njani.
Itheyibhile 2: Iindleko zokusinda kwiNtsholongwane kaGawulayo entsha
Umlinganiselo wokuSinda | Usuku Lokuqala Lokuxilongwa | |
Unyaka 5 | 99% | 2012 |
Unyaka 10 | 98% | 2007 |
Unyaka 15 | 94% | 2002 |
Ngaphezulu kweminyaka engama-15 | 86% | Ekupheleni kwee-1990 |
Cinga ukuba ixabiso lokusinda lingaqwalaselwa kuphela ngokuhamba kwexesha; Ukufa kwabantu abaneminyaka engama-10 kuphela kubalwa amadoda afunyaniswe kwakhona ngo-2007, kwaye ngemilinganiselo yanamhlanje, unyango emva koko lwaluqhelile. Ngoko ke, inani lokuphila elithembela kwi-teknoloji elidala lingafaneli limele ithemba lokugulisa unyango namhlanje. Izinga lokusinda liya kuqhubeka nokuphucula ixesha, kwaye, ukuba kukho nantoni na, abantu abanomdlavuza okhula ngokukhawuleza banomdla.
Ezinye iiNkqubo zoLondolozo lweeNgcaciso azizaliseki
Xa abantu bebuza oogqirha babo, "Ndiyiphi na inqanaba?" Abaqhelekanga ukuba kukho iindlela ezahlukeneyo zokusetyenziswa kwezicwangciso ezisetyenziswayo. Makhe sihlaziye ngokufutshane ezinye iinkqubo zesiteji:
- I-clinical staging (A, B, C, kunye no-D) ichaza ngokucacileyo indlela iprotate evakalelwa ngayo kwi-digital rectal examination (DRE). Le nkqubo yaqulunqwa phambi kokuba i-PSA iqulunqwe kwaye isetyenziswe ngabagqirha ukuqinisekisa ukuba ukusebenza kwe-prostatectomy enkulu kunamkelekileyo (Jonga iThebhile 3).
- I-pathologic stage ihambelana nomlinganiselo wesifo somhlaza esinqunywe ngugqirha okanye nge-biopsy.
- I-TNM Staging iquka ulwazi oluvela kwi-1 kunye no-2 kwakunye nolwazi olufunyenwe kwi-bone scans okanye kwi-CT.
- Isigaba sengozi, esahlukanisa amadoda asandul 'ukufumana isifo kwiindawo ezincinci, eziphakathi kunye nezingozi eziphezulu, usebenzisa ulwazi oluvela kwi-1 kunye no-2 kunye nenqanaba le-PSA.
Itheyibhile 3: Isigaba seZliniki (i-DRE Stage)
Isigaba | Inkcazo |
T1 : | I-tumor engakwazi ukuvakalelwa yiyo yonke i-DRE |
T2 : | Ukuxhaphaza kuvaliwe ngaphakathi kweprotate I-T2a: I-Tumor kwi <50% ye-lobe enye I-T2b: Ukulahla kwi> 50% enye ye-lobe kodwa kungabikho bobabini I-T2c: I-tumor ivakalelwa kwizinto zombini |
T3 : | Ukuqhaqhazela okuqhubekayo nge-prostate capsule I-T3a: Ukongezwa kwangaphandle I-T3b: I-tumor ehlasela i-vesicle (s) |
T4 : | I-Tumor ehlasela i-rectum okanye ibladder |
Iimpawu zeSigaba seBlue
I-Stage ye-Blue system isebenzisa zonke iisistimu zee-staging (1, 2, 3 kunye no-4 ezibhalwe apha ngasentla), kunye nequlethe inkcazelo malunga nokuba utyando olwenziwe ngaphambili okanye i-radiation yenziwe.
- Ukuhlolwa kwemilinganiselo yamadijithali: Isiqhelo ngokuqhelekileyo ngokumalunga nesisindo
- Isibalo seGleason : 6 vs. 7 vs 8-10
- I-PSA: <10 vs. 10-20 ngokumalunga no-20
- Iibhola ze-Biopsy: Ambalwa ngokumalunga nomlinganiselo olinganayo kunye nabaninzi
- Ionyango langaphambili: Ewe no
- Ukucinga: Isixa sesifo, nokuba sisemzimbeni okanye amathambo
Unokumisela isiteyinti sakho kwi-intanethi kwiwebsite ye-PCRI ngokuphendula imibuzo emfutshane embuzo kwi-stagingprostatecancer.org.
Yintoni Engalunganga Ngendlela Yokubeka Isichengeni?
Inkqubo yesigaba sokubeka ingozi, esakhiwa ngamacandelo amathathu aphezulu kwisihlomelo esibhaliweyo ngasentla, asibandakanyi ezininzi ezininzi ezibalulekileyo zokugxininisa ukuchaneka kokuchaneka kwesiteji:
- Iziphumo ze-Multiparametric-MRI
- Ipesenteji ze-biopsy-cores eziqulethwe ngumhlaza
- Inkcazelo ye-PET yokukhangela
Ngaphezulu kwelo, inkqubo yecandelo lomngcipheko alibandakanyi amadoda aphinde ahlaziya izifo, amadoda anama-hormone resistance, okanye amadoda aneemastastase emathanjeni.
Xa Uyazi I-Stage Yakho, Yiyiphi Imithi Eyona Impumelelo?
Ixabiso elibalulekileyo lokukwazi isigaba salo kukuba ivumela izigulane kunye noogqirha ukuba bangene kwizinto ezinokubaluleka kunonyango. Kule ntsalela yeli nqaku, ezinye iinkqubo zonyango zonyango zichazwe ngalinye kwisigaba.
Izulu
Ekubeni i- Sky (i-Low-Risk) yinxalenye engenakulimala, kwaye ekubeni ngoku siyazi ukuba uGleason 6 akaze ahlaziywe, ukubhala ngokuthi "umhlaza" ngumntu ongeyena mva. Ngokufanelekileyo, i-Sky ibiza kuthiwa yi-tumor enesifo kunokuba ngumhlaza. Ngenxa yoko, zonke iintlobo ezintathu zeNkqantosi , ( ezantsi, eziSisiseko kunye eziPhakamileyo) zilawulwa ngokuqwalasela okusebenzayo. Umngcipheko omkhulu kumadoda e- Sky kukusilela ukufumana izifo eziphezulu eziphezulu. Ngoko ukukhangela ngokukhawuleza nge-MRI multiparameter kwinqanaba lomhlaza elinesifo esinokuqonda.
Utywala
I-Teal (Ephakathi-engozini) yimeko ephantsi-bakala kunye neembono ezintle zokuhlala ixesha elide. Nangona kunjalo, abaninzi abantu bafuna unyango. I-exception yi- Low-Teal , apho uhlolo olusebenzayo luyamkeleka. Ukufanelekela njenge- Low-Teal iGleason kufuneka ibe ngu-3 + 4 = 7, kungeyi-4 + 3 = 7, isixa seBakala 4 kwi-biopsy kufuneka sibe ngaphantsi kwama-20 ekhulwini, i-3 kuphela okanye i-coop yecala ingaba nomhlaza, akukho inokuba ngaphezu kwama-50 ekhulwini anomdlavuza, kwaye konke okufunyenweyo kufuneka kufane neZulwini .
I-Basic-Teal ineengqungquthela ezininzi ezinomdlavuza kune- Low-Teal, kodwa kusekho ngaphantsi kwe-50 ezikhoyo. Amadoda aneziThutho ezisisiseko ngabagqatswa abafanelekileyo kwi-arhente ye-arhente enye malunga naluphi na uhlobo lwezinye iindlela zokwelapha zanamhlanje, kuquka ukufakelwa kwembewu, i-IMRT, unyango lweproton, i-SBRT, unyango lwe-hormone, kunye nokuhlinzwa.
I-High-Teal iquka nayiphi na imilinganiselo yemigqaliselo yesigulana seTyali esingenalo kwi- Low okanye Isiseko . I-High-Teal inamandla kakhulu kwaye kufuneka iphathwe ngonyango oludibeneyo olubandakanya i-IMRT, imbewu, kunye neenyanga ezine ukuya kweyesithandathu inyanga ye-hormone therapy.
I-Azure
I-Azure (High-Risk) iqulethe ezintathu. I-Low-Azure i-Gleason 4 + 4 = 8 kunye neebini okanye ezimbalwa ze-biopsy cores, akukho ncoko ye-biopsy ngaphezu kwe-50% ebandakanyeka nomhlaza, kunye nazo zonke ezinye izinto ezinjenge- Sky . Amadoda ane-Low-Azure athathwe ngendlela efanayo ne- High-Teal.
I-Basic-Azure iyona hlobo oluqhelekileyo lwe- Azure kwaye limela nayiphi na into ekwi- Azure ehluleka ukuhlangabezana nemigangatho ephantsi okanye ephakamileyo . I-Basic-Azure iyaphathwa nge-radiation, imbewu, kunye ne-hormone unyango lweenyanga ezili-18.
I-High-Azure ichazwa njengelinye okanye ngaphezulu kwezi zinto zilandelayo: PSA ngaphezu kwe-40, iGleason 9 okanye 10, ngaphezulu kwama-50 ekhulwini we-biopsy cores, okanye umdlavuza kwi-vesicles okanye i-pelvic nodes. I-High-Azure iphathwa ngokufanayo kunye ne- Basic-Azure, nangona mhlawumbi ngokungeniswa kweZytiga, Xtandi, okanye i-Taxotere.
Indigo
I-Indigo ichazwa njengomhlaza wesibeleko emva kokuhlinzwa okanye i-radiation. Ingaba i- Indigo i- Low, i-Basic okanye iphakamileyo iboniswe ngumdla wokusasazeka kumhlaza kwi-nuclevic nodes. I-Indigo ephantsi ibeka umngcipheko. Ukuze ufaneleke njenge- Low-Indigo, i-PSA kufuneka ibe <0.5 emva kokuhlinzwa kwangaphambili okanye <5.0 emva kwemisebe yangaphambili. Kwakhona, ixesha le-PSA eliphindwe kabini kufuneka libe>> iinyanga ezi-8. Ukongezelela, i-Initial Stage yeBlue phambi kokuhlinzwa okanye imisebe kufuneka ibe yiNtsundu okanye iTyal . Utyando lwe- Low-Indigo lungaquka umbane (emva kokuhlinzwa kwangaphambili) okanye i-salvage cryotherapy (emva kwemitha yangaphambili).
I-Basic-Indigo ithetha ukuba iziphumo zokujonga kunye neentsholongwane azibonisi iiseli ezinqamlekileyo (ezaziwa ngokuba ngamanzi), kodwa iikhrayitheriya ezifanelekileyo ezikhankanywe apha ngasentla ze- Low-Indigo azihambelani. Ngamanye amazwi, enye okanye ngaphezulu kweemeko ezibonisa ukuba amamitha ase-pelvic amancinci anokuba khona. Nge- Basic-Indigo , unyango oludibeneyo olunefuthe kunye neemitha kwii-pelvic node kunye ne-hormonal therapy kufuneka zisetyenziswe.
I-Indigo ephakamileyo ibonisa ukuba iimitha zibonakaliswe ukuba zikhona kwi-lymph nodes. Unyango lwe- High-Indigo lufana neSiseko - Indigo ngaphandle kokuba unyango olongezelelweyo kunye neZytiga, Xtandi, okanye i-Taxotere lunokuqwalaselwa.
Royal
Amadoda aseRoyal angaba ne-hormonal-resistant (i-PSA ephakamileyo kunye ne-testosterone ephantsi) okanye i-metastase ngaphaya okanye ngaphandle kwee-pelvic nodes (okanye zombini). I-Royal Royal i- " Royal " iyimimandla yokuxhatshazwa kwamakhomitha ngaphandle kweyiphi na i-metastases ebonakalayo. La madoda aphantse ukuba neengxaki ezincinci zesifo se-metastatic kodwa kungenakwenzeka ukufumana ithambo eliqhelekileyo okanye i-CT scans. Entsha, i-PET enamandla ngakumbi efana ne-Axumin, i-PSMA, okanye i-Carbon 11 ingafuneka ukuba ifumane i-metastases. Emva kokuba i-metastase ikhona, unyango luya kufana ne- Basic-Royal .
I-Royal-Basic isingeniso sokungabikho kwemeko yesifo se-metastatic (ngaphandle kweplavis) kodwa inani elipheleleyo leemastastases lihlanu okanye ngaphantsi. Unyango lwe- Basic-Royal iyintlangano ye-SBRT okanye i-IMRT kuzo zonke iziza zesifo esaziwayo, Ukubonelela nge-immunotherapy, kunye neZytiga okanye i-Xtandi.
I-Royal-Royal ithetha ukuba i- metastases engaphezu kwe-5 ifunyenwe. I-SBRT okanye i-IMRT ngamaninzi amaninzi aqhelekanga. Xa lesi sifo asiqhubeki ngokukhawuleza okanye sibuhlungu, unyango lufanele lube neNkxaso elandelwa yiZytiga okanye i-Xtandi. Isifo esibuhlungu okanye esiphuthumayo sifanele siphathwe nge-Taxotere.
> Imithombo:
> D'amico, uAnthony V., et al. "Isiphumo esekelwe kwisigxina kwi-clinical adenocarcinoma yeprotrate." Umbhalo we-urology 158.4 (1997): 1422-1426.
> Frank, uSteven J., et al. "Isicatshulwa sesiqendu II sesigxina se-prostate brachytherapy esisisigxina se-prostate yomhlaza wendawo: i-effectiveness, inetyhefu, kunye nemiphumo yeziphumo zobomi." I-International Journal ye-Radiation Oncology * I-Biology * I-Physics (2017).
> Izibalo zengxowanxu ye-prostate 2017. https://www.cancer.net/cancer-types/prostate-cancer/statistics
> Sylvester, uJohn E., et al. "Unyaka we-15-biochemic uhlaselwa ngokukhululeka kwi-klinikhi yomhlaza weT1-T3 umhlaza wesifo seprotate emva kokugqithiswa kwe-radiotherapy kunye ne-brachytherapy; amava ase Seattle." I-International Journal ye-Radiation Oncology * I-Biology * I-Physics 67.1 (2007): 57-64.