Xa ndiqeqeshelwa ukuba yi-urologist kuma-1980, ukuhlolwa kwegazi lwe - PSA esiyisebenzisa ngoku ukukhangela umdlavuza weprotate kwakungekabikho, kwaye ukufumana i-prostate tumor kwakuyinxalenye yengozi.
Oogqirha mhlawumbi kwenzeka kwesohlwayo esikhankqalaza xa bevavanya i-prostate yesigulane ngesigxina somnxeba ngexesha lokuhlola ngokuqhelekileyo (uvavanyo oluqhelekileyo lwama- digital rectal ), okanye wenza ukuxilongwa emva kweempawu ekugqibeleni kwashukumisela umntu ukuba amisele ukuqeshwa kwegqirha ukuze athole into engalunganga.
Kwakungekho imeko efanelekileyo yokubamba umdlavuza wesifo seprotate ekuqaleni kwayo, isigaba esinokuphulukiswa kakhulu.
Kwiminyaka engamashumi amathathu edlulileyo, isiqingatha seentsholongwane ezandul 'uvavanyo zazibandakanya umdlavuza wesifo seprotate esasisasazeka kwezinye iindawo zomzimba ngexesha lifunyenwe. Ukugqithwa komhlaza wesifo seprotate ndandenza njengomntu ohlala kwi-urology esusa iintsholongwane zezigulane-inzame yokwelapha i-cancer ephezulu ngokubulawa yindlala ye-testosterone ukuba i-tumors isebenzisa njengamafutha.
Iiplato zePSA
Ukufika kovavanyo lwe- PSA kwiminyaka ye-1990 kwasenza sikwazi ukujonga i-screening ye-prostate yomdlavuza ngendlela efanayo yokuba sijonga amazinga aphezulu e-cholesterol njengesilathisi sokuqala sesifo senhliziyo. Izigidi zamadoda ziye zavavanywa, kwaye iziphumo ziye zasinceda sibone izicubu ezinobungozi ezingaphathwa ngempumelelo, njengokuba umbonisi kaBen Stiller wabonisa.
"Uvavanyo lwePSA" kwiminyaka engama-50 lunokubonisa ubungozi bomntu obunomdla wokuvelisa umdlavuza weprotate kwaye uncede yena kunye nogqirha bakhe bathathe isigqibo sokuphindaphinda kaninzi iimvavanyo.
Ukuba ukufunda kungaphantsi kwe-0.7 i-nanogram / i-milliliter (umyinge wabantu abaneminyaka engama-50 ubudala), umngcipheko wobomi be-prostate umdlavuza ungaphantsi kwama-10 ekhulwini kwaye i-PSA yokujonga i-PSA mhlawumbi iyafuneka kuphela kwiminyaka emihlanu. Ukuba izinga lingaphantsi kwama-2 i-nanogram / i-milliliter kwiminyaka engama-60, umngcipheko wokufumana umdlavuza we-prostate obungozi okanye ukufa kwayo ngowama-2 ukuya kuma-3 ekhulwini, kwaye ukulandelwa kwe-PSA vavanyo kungancitshiswa okanye kupheliswe.
Iimfuno zePSA
Nangona uvavanyo lwePSA luxabisekileyo, aluphelelanga . Ilinganisa inani leprotheni elibizwa ngokuba yi-prostate-specific antigen, okanye i-PSA, ejikeleza ngegazi. Ii-PSA zenziwe ngamaseli kwi-prostate gland. Nangona iphakamileyo lePSA eliphakamileyo linokubangelwa ngumhlaza, manani nawo angakhuliswa ngenye iimeko zonyango, ezifana nokusuleleka kunye nokwandiswa komzimba weprotate eyenzeka njengeminyaka yobudala. Nangona ukunyuka kwe-PSA ngokukhawuleza, kwi-test eyodwa ukuya kwesilandelayo-umlinganiselo obizwa ngokuba yi-PSA velocity-ayikho isalathisi esinokwethenjelwa ngokwaloobukho bomhlaza wesibeletho.
Ukongezelela, akukho nca ecacileyo, i-PSA yenqanaba "eliqhelekileyo". Amadoda amaninzi anamazinga aphakamileyo ePSA kwigazi lawo awanayo umdlavuza wesifo seprotate, ngelixa amanye aphantsi kwamazinga e-PSA enza. Kukho ubungqina bokuba amanqanaba e-PSA kunye nezinye iimpawu ze-PSA zahlukileyo kumadoda ase-Afrika nakumaMerika kunokuba abamhlophe.
Ngenxa yesiphumo sokungabonakali, amanye amadoda angenazo i-biopsy yokugonywa ngokugqithiseleyo kwaye angagqiba ukufumana unyango lwezonyango ezingekho mfuneko, ngelixa abanye abantu abafuna unyango abafumaneki ngokukhawuleza.
Ingxaki yokuXela
Ekugqibeleni, iziphumo zePSA zodwa azikwazi ukuqikelela ikhosi yekamva yeprotate.
Uninzi lweengcambu zesisu ziphantsi kobungozi, zikhula ngokukhawuleza, zibangele ezimbalwa okanye zingekho iimpawu, kwaye azidingi unyango. Ezinye izicubu zikhula ngokukhawuleza kwaye zingasasazeka kwezinye iindawo zomzimba. Kucacile ukuba sifuna ukwazi uhlobo luni lomhlaza isigulane esinako ukuze senze iziphakamiso ezifanelekileyo zonyango, kodwa amanqanaba e-PSA asincedi naloo sigwebo.
I- prostate biopsy , ebonisa isampula kwiindawo ezixhasayo kwiimviwo zebhubhoratri, inokukunceda ukuhlukanisa izicubu ezinjengezantsi, eziphakathi, okanye eziphezulu zokubeka ingozi usebenzisa indawo ebizwa ngokuba ngumlinganiselo weGleason, kodwa iyazithoba kwaye ayisoloko ibonisa ukutshutshiswa komhlaza.
Kwaye inqaku lovavanyo olufanelekileyo lokunciphisa ukunciphisa imfuno ye-biopsies, kuba ingakhathazeki, ibangele uxhalaba kwaye ibe nemiphumo emibi.
Iindaba ezilungileyo kukuba ukuphucula iimvavanyo zokuphonononga kunye nezinye izixhobo zokuxilonga ziyafumaneka, nto leyo ifanele isincede "ngomhlaza / umhlaza" kunye "nokunyuka okukhawulezayo / okugwenxa". Makhe sibone.
Uvavanyo lweSicreen Screening
Uvavanyo oluninzi lweemvavanyo kwiimarike luye lwaboniswa ukuba luchaneke ngakumbi kunophononongo lwe-PSA ekufumaneni ubukho okanye ukungabikho komhlaza wesifo seprotate, kunye nokufumanisa umdlavuza onobungozi obuphezulu omele uphathwe. Ziyasetyenziswa ngokubambisana-kungekhona endaweni yokuhlolwa kwe-PSA, kwaye zenzelwe ukunceda izigulane kunye noogqirha banquma ukuba ngaba i-biopsy iyadingeka emva kwempembelelo ephakamileyo yokuhlolwa kwe-PSA.
Uvavanyo lwegazi okanye umchamo lubandakanya i-4Kscore ™ , i-Index ye-Prostate Health Index, i-Mi-Prostate Score, kunye ne-ExoDx ® Prostate (IntelliScore). Ngamanye uhlalutya ukudibanisa okukhethekileyo, okubambisene neentlobo zendalo, okanye izibonakaliso ze-biological, zomhlaza. Abanye baphinde balinganise i-PSA, kodwa ngeendlela ezahlukeneyo ngaphandle kovavanyo oluqhelekileyo. Ngokomzekelo, uvavanyo (alukabikho kwezoqoqosho) olubizwa ngokuba ngu-IsoPSA ™ oluphuhliswe yiCleveland Clinic kunye neCleveland Diagnostics, Inc., lubheka utshintsho oluhlukile kwi-molecular molecular protein.
Nangona iimvavanyo ezintsha zokuhlola iyanciphisa i-biopsies engadingekile, akukho ne-Medicare okanye abanomshuwalense wangasese uya kubahlawula ngokuqhelekileyo (abanye abathwali banokubambisa kwiimarike zendawo) -i-carryover, mhlawumbi, kwiinkxalabo zabo zangaphambili ukuba uvavanyo lwe-PSA lufumanisa amaninzi eekreleksi ezingaphantsi kwee-grade ezingazange zifune ukuphathwa. Izigulane zinokufuneka zithwale iindleko, ezinokuba zingamakhulu angama-dollar.
Ezi mvavanyo zisebenzisekile kwiimeko apho zingacacanga ukuba iPSA ekhulayo ibonisa umdlavuza, kwaye kwizigulane ezinePSA ekhulayo kunye ne-biopsy yangaphambili.
Indlela Efanelekileyo Yobomi
Kubantu abanemiphumo engavumelekanga kuyo nayiphi na le mvavanyo, inyathelo elilandelayo li-biopsy. Kule nqubo sithatha iisampula zee-prostate tissue ze-pathologist ukuhlola ngaphantsi kwe-microscope ukukhetha ukuba ngaba umhlaza ushona. Kukho ukuhanjelwa kwangoku, ukuhambela phambili apha, naye.
Ukufumana iisampula zamathambo, siphuca uluhlu lweedilesi (ukusuka ku-12 ukuya ku-24) ukuya kwiindawo ezahlukeneyo zegland, ekhokelwa yi-ultrasound scan. Sisebenzise le ndlela ukususela kuma-1980. Iprotrato encinci, malunga nobukhulu beelnut, imifanekiso e-ultrasound isinceda ukuba sibe neenaliti ngokufanelekileyo. Kodwa imifanekiso ayifumanekanga ngokwaneleyo ukuba sixelele ukusola, indawo ezinomdlavuza ezivela kwimizimba evamile.
Inyaniso kukuba sisebenzisa indlela yokusabalalisa, enethemba lokuba, ukuba i-tumor ikhoyo, ubuncinane enye yeesaliti iya kuhlangana nayo. Ezi biopsies ezingahleliwe zingaphuthelwa izidumbu ezinobungozi, ngelixa zityhila abanye abangabonakaliyo kwaye banokuphela baphathwe ngokungadingekile.
Ngethamsanqa, i-MRI scan ebizwa ngokuthi i-MRI multiparametric iyakwazi ukwahlula phakathi kwezicubu ezinobungozi ezinobungozi.
Kuya kuba nzima ukwenza i-biopsy ngelixa isigulane singaphakathi kwe-MRI scanner. Kodwa asimele. Isofthiwe entsha isenza sidibanise, okanye fuse, ezo zicatshulwa ezicacileyo ze-MRI zokujonga imifanekiso ephilayo, yangempela-yesikhokelo esiluncedo ukukhokela iinaliti ze-biopsy. Isigulane sokuqala sifaka iMRI. I-radiologist iyihlolisisa kwaye ibalasele iinkalo ezinolumkiso. Kamva, kwimeko yokuhlinzwa yonyango, sifaka iprojekiti ye-ultrasound kwisigulane sesigulane, kufuphi neprotate.
Isofthiwe yefusion idibanisa iMRI esele ikhona kwaye ihlala imifanekiso ye-ultrasound. Njengoko sisusa iprojekti ye-ultrasound malunga neprotate, isofthiwe ishintshela umfanekiso we-MRI ngokufanelekileyo, isinika umbono obanzi, 3-D. Singawusebenzisa lo mfanekiso ochanekileyo ukujolisa kwiinaliti ze-biopsy kwisihlunu sifuna ukusampula endaweni yokuphalaza kwaye sithemba ukuba siyifumana into. Kufana nokusebenzisa i-GPS ye-GPS ukufikelela kwindawo ekuya kuyo kunokuhamba ngaphandle kwekhokelo.
Umngeni ngale ndlela, ebizwa ngokuba yi-MRI / transrectal ultrasound (TRUS) i-biopsy ekhokelwa ngumbumbano, kwakhona iindleko. Ukukhangela ku malunga ne-$ 1,500 kunye neenkampani ze-inshorensi ngokuqhelekileyo aziyi kuhlawulela kwizigulane ezine-biopsy yazo yokuqala. Baza kuwugubungela xa kusetyenziselwa ukuphindaphinda i-biopsy okanye kwizigulane eziye zafunyaniswa ngokuba nomhlaza wesibeletho.
I-biopsy ekhokelwa yi-Fusion ayifezekanga. Olunye uphando lufumanise ukuba lulahlekelwa ubuninzi bee-prostate tumors njengoko kukho i-biopsy eyiyo. Kodwa i-cancer ephosakeleyo yinto enokwenzeka kakhulu ukuba ibe yintsholongwane engabalulekanga ukuba ayifuni ukuphathwa. Kwaye i-biopsy ekhompyutheni ekhompyutheni ibonakala kakuhle kakhulu ekuboneni izicubu ezinobundlobongela.
Ukubikezela iCancer Cancers
Ukusinceda ngakumbi nangaloo vavanyo, kukho iimvavanyo ezintsha ezinokuhlalutya izicubu ze-biopsy ngeempawu zamanc Olu vavanyo lwe-genomic-I-Oncotype DX ® iGenomic Prostate Score, i-Decipher ® i- Prostate Cancer Classifier, i-ProMark ® Iproteomic Test Prognostic kunye novavanyo lwe-Prolaris ® -khangela ukungazinzi kwe-DNA ephawulekayo yokukhula kwezidumbu.
Ukongezelela, iimvavanyo ze-Oncotype DX kunye neProMark zikwazi ukuqikelela ukuba kukho umhlaza ophezulu wobungozi obufihlekele kwenye indawo kwiprotrate, kwiindawo ezingazange zatshintshwe ngeenaliti ze-biopsy. (I-Cleveland Clinic incede ukuphuhlisa i-Oncotype DX kwaye ithathe inxaxheba ekuphandeni okuqinisekisile i-Decipher ne-ProMark.)
I-Medicare kunye neenkampani zomshuwalense zihlawula iindleko zale mvavanyo yeziganeko zezigulane ezenza iziphumo ezenza izifo (iziganeko zeGleason ndikhankanywe ngaphambilana) zibonisa ukuba khona kwezicubu ezincinci kakhulu okanye ezisezantsi. Ngokuqhelekileyo abahlawulanga ukuvavanywa kwangaphambili kwiimeko apho i-Gleason izikolo zibonisa izibilini eziphakathi nentsholongwane.
Ngeziphumo zezi vavanyo ze-genomic, oogqirha kunye nezigulane zinokwenza izigqibo ezinolwazi malunga nendlela yokuqhuba-nokuba ngaba unyango olukhawulezileyo olunjengokukhishwa kwe-prostate, okanye ukuhlolwa ngenyameko, oku kuthetha ukuhlolisiswa kwexesha kunye nokuhlaziywa kwakhona kwesimo somhlaza.
UDkt. Klein nguSihlalo we-Cleveland Clinic ye-Glickman ye-Urological & Kidney Institute, isizwe sikaNombolo 2 se-urology program njengoko sikhethwe ngu-US News & World Report.
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> Klein EA, Cooperberg MR, Magi-Galluzzi C, et al. I-test-gene ye-17 yokuhlaziya umdlavuza womhlaza wesifo seprotate kumxholo we-Gleason grade heterogeneity, i-tumor multifocality, kunye ne-biopsy. Eur Urol . 2014 Sep; 66 (3): 550-60.
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