Ekubeni kukho iintlobo ezintathu zemingcipheko eyahlukeneyo yomhlaza wesibeletho esandul ' uvavanyo-oluphantsi, oluphakathi kunye nolona luphezulu luyahlukahluka. Ngokuqhelekileyo, indlela yethu yokukhuthaza ukugadwa ngokukhawuleza kwizigulane eziphantsi kweengozi, ukufakelwa kwembewu kumadoda aneengozi eziphakathi komhlaza, kunye nokuveliswa kwembewu kunye neyeza elongezelelweyo kumadoda kwindawo ephezulu yokubeka ingozi . Ezi zigqibo zenziwa ngokusekelwe kuphando oluqhathanisa iziphumo phakathi kweyeza ezahlukeneyo.
Ugqirha okanye i-Beam Radiation?
Nangona kunjalo, ezininzi iingcali azivumelani. Ngokwesiko, zimbini iintlobo zokhetho lwezonyango, utyando okanye i-radiation radiation, zenziwa ngabagqirha kunye neengcali ze-radiation, oogqirha abaqhele ukulawula amadoda anomdlavuza wesibeletho. Imbewu yokujonga okanye i-radioactive, eyaziwa nangokuthi i-brachytherapy, ihlala iphuma ngaphandle kwengxoxo.
Kwaphela iminyaka, kugxininiswe kwingxoxo phakathi kokuhlinzwa kunye nemisebe, umbuzo othi, "Ingaba kukho enye into engcono?" Kwaye "ngokubhetele", sithetha ukuba: yintoni unyango olunezinga eliphezulu kakhulu lokunyanga kunye nefuthe eliphantsi kakhulu kwi-urinary nesondo msebenzi?
Sekude sikhankanywe ukuba utyando kunye nemirhumo ineziphumo ezifanayo, kodwa ukuthelekiswa kwezesayensi kumgangatho wokugqiba ukuba omnye ulungile kangcono kunomnye ongenakho. Ngako oko, izigulane kunye noogqirha banamathele ngokuxhomekeke kwimvakalelo kunye nangokwenene malunga nokwenza iinqununu eziqhelanisiweyo.
Nangona kunjalo, amadoda afuna iimpendulo ngoku anikezelwe ngokuphuhlisa ngokutsha-ukupapashwa kwentloko ukuya kwintloko, isilingo esilungelelaniso lwekliniki ngokuthelekiswa nokutyunjwa, ukuchithwa kwemitha, kunye nokujonga ngokukhawuleza.
Izilingo ezingenakulinganiswa zikhethekileyo kuba ziphendule umbuzo othize ngokuphumelelayo, ukunyanzelisa ukupheliswa kweengxaki, ingxaki ephakamileyo kunye nezilingo ezibuyiselwayo (ngaphezu kwamaphesenti anesithoba anesithoba eesilingo ngokuthelekisa ukuhlinzwa kunye nokukhanya kweemitha).
Isizathu sokuba kuncinci ukuhlola iziphumo kukuba abaphandi kufuneka bafumane izigulane ezikulungele ukuba zonyango zikhethwe ngononophelo. Kwilingo elixutywe apha ngezantsi, amadoda kufuneka 'athabathe umgca' ukuze achaze ukuba ngubani oza kutyunjwa, umbane okanye ukulinda kwenkqubo ebizwa ngokuthi "i-randomization".
Izifundo ezininzi zibuye zikhona, uzame ukuthelekisa iziphumo zemizila kunye nokuhlinzwa. Zingcolileyo, nangona kunjalo, ngezinto ezininzi eziphazamisayo, umzekelo omnye ungamaxesha angalingani kwezigulane. Ngokuqhelekileyo, amadoda amancinci abelwe ukuhlinzwa kunye namadoda amadala baphathwa ngemitha.
Ukuthelekiswa okunjengaleyo kungafanelekanga kuba kuyaziwa ukuba amadoda amancinci anemiphumo engcono kungakhathaliseki ukuba yintoni na unyango olwenziwa ngayo. Kuze kube ngoku, ekubeni kuphela "idatha yenzululwazi" ibe yinto efunyenwe yinkcazelo ephuma kumaqela angalinganiyo, oogqirha bekhululekile ukukhetha nayiphi na ifundwayo yokufunda ixhasa ubuncwane babo ukukhusela isikhundla sokuba unyango olulodwa lugqwesileyo olunye.
Uhlolo lokuSebenza
Ngoko kutheni kungekho naluphi na ulwazi olulindelekileyo oluqhathaniswa nokuhlinzwa, ukukhanya kwemitha, kunye nokuhlola okusebenzayo? Okokuqala, ezo zilingo zibiza kakhulu. Amakhulu amadoda kufuneka ahlolwe iminyaka engaphezu kwelishumi.
Okwesibini, kunzima ukufumana amadoda azimisele ukukrazula iintlobo zokukhetha unyango. Okwesithathu, ekubeni izilingo zithatha ixesha elide ukuba zikhule, ukuyila uvavanyo olunjalo kufuna ubulumko bokubonisana ukuqinisekisa ukuba umbuzo ophendulwa ngolu vavanyo uya kuba ne-15 eyiyo kwixesha elizayo.
Njengoko kunzima njengokuba kungenangqiqo, iilingo ezilindelekileyo ziyakuxhaswa kwaye zenze, ziyimfuneko kakhulu. Ukungabikho kwezilingo ezinokuthi zihlale zikhokelela ekuphikisaneni nasekugqibeleni. Ngaphandle kolwazi oluchanekileyo, ukhetho lwezocwangciso luphela luqhutyelwa ngokunyanzeliswa ngqalelo kwezemali -unyango oluhlawulela eyona nto iyona ethandwa kakhulu.
Ngoko ukupapashwa kwemihla ngemihla ngokulandelelana ngokukhawuleza neziphumo zonyango lotyando, ukukhanya kwemitha kunye nokujonga ngokunyanisekileyo ngokwenene kuyimbali. Ezi ziganeko eziphawulekayo ezenza ukuba ekugqibeleni siqonde umgangatho ophantsi.
NgoSeptemba 2016, iNew England Journal of Medicine yashicilela isihloko esithi "Iziphumo Zonyaka Zama-10 emva kokuGada, ukuPhepha, okanye i-Radiotherapy yeCape Prostate Cancer". Kule vavanyo, amadoda angama-1650 ayetyenziswe ngokukhawuleza ukuba ahlolisise, asebenze, okanye asebenze ngokukhawuleza, kwaye alandelwe iminyaka elishumi. Uhlobo lwamadoda athathe inxaxheba kwilingo lwaluqhelekileyo kumntu oqhelekileyo onokufumanisa ukuba unesifo sesantya-phambili ngePSA yokuhlola . Ubudala babo beminyaka engama-62.
Amathathu anesine kwala madoda ayengenanto yokuxilongwa kwi-digital prostate yoviwo kwaye enye yesine yayinokungaqhelekanga. Kancinci ngaphezu kweyesithathu-yesine yamadoda yayingu-Gleason amathandathu. Enye yesihlanu yamadoda yayingumlinganiselo wesi-7 kunye neyodwa kwindoda engamashumi amane inomlinganiselo ophezulu weGleason, we-8 kuya kwe-10.
Emva kokuvuma ukuthatha inxaxheba kwisifundo , amadoda anikezelwe ukuba asebenze ngokukhawuleza, i-radiation esheshayo okanye uhlolo olusebenzayo. Abo babelwe ukuba baphenywe babenokuhlolwa rhoqo kwesifo ukuze unyango luqaliswe njengoko luyimfuneko.
Ngaphezulu kwexesha eli-10 elilandelelweyo lokubheka, malunga nesigamu samadoda ekubhekisweni kwonyango olwenziwe ukulibaziseka kunye nokuhlinzwa okanye imitha. Kuyathakazelisa ukuba ininzi yamadoda ekuhloleni okhethwe unyango yenzelwe izizathu zengqondo kunengqiqo. Ngamanye amazwi, banquma ukufumana unyango nangona amaxesha amaninzi kwakungekho ubungqina bokuba isifo sabo siphumelele.
Wonke amaqela omathathu amayeza aye ahlolisiswa ngenxa yokufa kwe-prostate-related mortality. Emva kweminyaka elishumi, kwakukho abantu abangama-17 abafayo benxulumene nomhlaza weprotate basasazeka phakathi kwamaqela amathathu-i-1 pesenti kwiqela ngalinye-kanti i-169 yokufa yenzeke kwezinye izizathu ngaphandle komhlaza wesifo somhlaza. Ukufa kwabangu-17 kwaba-17 kwenzeka kwizigulane ezineqondo lokuqala laseGleason eli-7 okanye ngaphezulu. Ukufa kwaxelwa kumadoda angama-8 kunye no-Gleason 6 kodwa ekubeni eli vavanyo lenzelwe iminyaka emininzi edlulileyo, ukuxilongwa kuxhomekeke kwi-biopsy engahleliyo kunokuba i-IM imaging. Izifundo ezininzi ziye zabonisa ngokucacileyo ukuba i-biopsy engahleliyo ilahleka izifo eziphezulu kakhulu ngokuphindaphindiweyo kuneMRI ephakamileyo.
Eyona nto ibaluleke kakhulu ekuthatyathwe kulolu vavanyo kwakukho phakathi kwamaqela amathathu, akukho ntlukwano kumaxabiso okufa ngaphezu kweminyaka eyi-10.
Thatha iCandelo loFundo
Ngoko ngokwelo lwazi olutsha kunye noluthembekileyo, inani lokufa kwabantu elishumi elineminyaka elishumi lihlala lilandelelana ngokufanayo nokuba isigulane sikhetha utyando, imisebe okanye ukuhlolwa okusebenzayo. Kuthiwani ngomgangatho wobomi? Inqaku elihamba naye kwinqanaba elikhankanywe ngasentla lishicilelwe kwiNew England Journal ngosuku olufanayo, ukunika ingxelo ngemiphumo yempilo-mpilo nganye kwizinto ezintathu zonyango ezihlobene nomsebenzi wesondo kunye nomsebenzi wokucoca. Ngokuphathelele umsebenzi wesondo, i-sibini yesithathu yamadoda ekufundwayo yayinamandla ngaphambi kokufumana unyango. Emva konyaka omnye, ipesenteji zamadoda ezigcina ingqondo, oko kukuthi, zineziqulatho "zomelele ngokwaneleyo ukulala" zilandelayo:
- Ukuqwalasela okusebenzayo = i-49 ekhulwini
- I-radium yangaphandle ye-radiation = iipesenti ezingama-38
- Radical prostatectomy = iipesenti ezili-15
Ngenye inyanga emva kokuqalisa isifundo, amadoda aphinde aphendule malunga nobukho okanye ukungabikho kokuvuza kwamanzi okudinga ukusetyenziswa kweepads. Ipesenti enye yamadoda yabika ukusetyenziswa kweepads ngaphambi kokuqala kokufunda. Iingxaki ngenxa yokugqithisa ngokugqithiseleyo kwexesha lokuhlwa kwakunjalo kuwo onke amaqela amathathu kwaye zahlala emva koko unyango. Emva konyaka omnye, iphesenti yalabo basebenzise iipasiti:
- Ukuqwalaselwa okusebenzayo = iipesenti ezi-4
- I-radium yangaphandle ye-radiation = iipesenti ezi-4
- Radical prostatectomy = iipesenti ezingama-26
Ukudibanisa iziphumo zezi zilingo zimbini zingentla, ngoku singayiphendula umbuzo wonyango olwaphi na amazinga aphezulu kunyango kunye nemiphumo encane yemiphumo emibi? Ukugqithisa, ukukhanya kwemitha, kunye nokuhlola okusebenzayo konke kunomphumo wokusinda okufanayo, kodwa ukuhlola okusebenzayo kuphuma kunye nemali engaphantsi kwemiphumo emibi .
Enye impendulo ekubhaliweyo malunga nengalo ejongene nolu vavanyo ingentla kukuba ukuqhubela phambili komhlaza, oko kukuthi iziganeko ze-metastasis zazingekho ngaphantsi kwamadoda aphethwe ngunyango okanye i-radiation ngokuthelekiswa namadoda ayebekwe kwi-13-maqondana nama-16 ngokumalunga nama-33 ngokulandelana. Ngoko ke, ukuba singayithobeli umgangatho wobomi ngokupheleleyo kwaye sichaza "amazinga okunyanga" njenge "inkululeko yokuqhubela umhlaza," kunokuba "uphile", iqela lokulinda libi kakhulu kunokuba kutyunjwe okanye kumaqela omlilo, kungekho nantlukwano phakathi kokuhlinzwa kunye nemitha .
Nangona kunjalo, njengoko kuphawuliwe ngasentla, enye ingxaki ngezilingo zokutolika eziye zenzelwe iminyaka eyi-15 ukuya kweyadlulileyo edlulileyo kukuba zixhomekeke kwi-teknoloji engaphelelwa yisikhathi. Ukunyanga kwamazinga okuhlinzwa kunye nemirhumo yatshintshile kakhulu, ukuba ikhona, ngaphezu kweminyaka eyi-15 edlulileyo.
Nangona kunjalo, iteknoloji yokubeka esweni kwindoda ngokubhekelelwa ngokukhawuleza iye yaphuculwa kakhulu ngokufika kweemifanekiso ezichanekileyo ngeMRI ephakathi. Ukucinga kwangoku kunciphisa kakhulu umngcipheko wokulahleka kwezifo eziphezulu ezingabonakaliyo, ingxaki eqhelekileyo enxulumene nokubeka iliso ngokuxhomekeke ekuhloleni nge-biopsies engahleliweyo. Le mihla, iteknoloji ye-MRI ye-parametric iyakwazi ukuqinisekisa ukuhlukaniswa ngokuchanekileyo kwinqanaba lokunciphisa umngcipheko wokuqhubela phambili komhlaza kubantu abafuna ukuphinda bahlolisise.
Izimpembelelo zeMbewu
Olunye uphumelelo lwezobuchwepheshe luye lwaqonda ukuba ukuveliswa kwembewu yomsakazo kubangelwa amazinga okunyanga aphezulu kunokuba kubekho ukukhanya kwemitha. Kwenye uphando olusandul 'uxwebhu olusandul' kutshanje lwakutshanje oluqhathaniswa neziphumo zemizila emisebe yodwa kunye nombane kunye nokufakelwa kwembewu, ukunyanga kwamazinga kunye nokufakelwa kwembewu kuboniswe ukuba kuphezulu. Bonke aba bantu kulolu vavanyo babe neentlobo ezingekho phantsi kweengozi eziphakathi okanye umhlaza womhlaza wesifo seprotate.
Kwiminyaka emihlanu emva kokonyango, izinga lokunyanga kwimizi yodwa yimivuzo engama-84 ekhulwini ngelixa iqondo lokunyanga imitha ye-radiation i-seed seeds yayingama-96 ekhulwini. Emva kweminyaka engama-9, inzuzo yembewu yayibaluleke nakakhulu. Ngaphandle kwembewu, izinga lokuphilisa lalingama-70 ekhulwini kuphela ngelixa ama-95 ekhulwini amadoda afumana ukuhlanganiswa kwemitha kunye nembewu yahlala yanyanga.
Ngokucacileyo, iimpembelelo zembewu zikhuthaza kakhulu ukunyanga amazinga. Kukho ilingo elongezelelweyo elongezelelweyo elihlola indlela iimpembelelo zembewu ezihamba ngayo ngokwazo, kungekho naluphi na umbane werama. Olu vavanyo lwafundwa ngamadoda angama-558 angabonakaliyo phakathi kweemitha kunye nembewu ngokuchasene nembewu yodwa. Umlinganiselo wesilinganiso seGleason u-7 kunye ne-PSA yayingaphantsi kwe-10. Emva kweminyaka emihlanu emva kokonyango, izinga lokunyanga lilinganayo kumaqela ama-85 kunye nama-86 ekhulwini ngokulandelana.
Imiphumo emide yexesha elide, nangona kunjalo, yayingaphantsi kwembewu yodwa, iipesenti ezi-7 kunye neepesenti ezili-12 zamadoda athola inxaxheba. Olu vavanyo lubonisa ukuba imisebe yongezwa kwimbewu ayimfuneko kwaye inetyhefu kunemimiselo yegazi eyenziwa yodwa.
Ukutolika Iinkcukacha
Yintoni okufanele uyenze njengesigulane ukususa kule datha? Ukuqwalasela iindidi ezi-3 zomhlaza wesifo seprotate, kulabo bafana neprofayili, ukuhlolwa ngenyameko kubanzi isinyathelo sokuqala esona siphumelele kubantu abanobuchopho obuphantsi. Unemiphumo engaphantsi kwayo kunye nesiphumo esifanayo sokufa njengabantu abakhetha ukuhlinzwa okanye imitha. Ngoku ukuba sinendlela echanekileyo yokuskena aba bantu kwizifo eziphezulu eziphezulu kwi-MRI, i-surveillance esebenzayo iba yindlela ekhangayo ngakumbi.
Amadoda anomhlaza womhlaza wesifo sonyango ophezulu kunye ne-high risk risk prostate kufuneka aphathwe nge-seed plant. Imfuno yokongezwa kweminye imililo kufuneka ibuzwe ngokubanzi. Ngoku ngeenkcukacha ezithembekileyo zokuxhasa ezi ndlela ezincinci ezingenayo, kokungaqiniseki kunye nokunyamezela okukhethiweyo kukhethwe kwonyango kuncitshiswa kakhulu.
> Imithombo:
> I-American Cancer Society. Iindleko zokusinda kwiCarstate Cancer.
> Cooperberg MR. Ukuqwalaselwa kwexesha elide lomhlaza wesifo somhlaza: iimpendulo kunye nemibuzo. J Clin Oncol. 2015; 33 (3): 238-40.
> Hamdy FC, uDonovan JL, uLane JA, et al. Iziphumo zeNyaka ezi-10 emva kokubeka iliso, ukuPhepha, okanye i-Radiotherapy kwiCape Prostate Cancer. N Engl J Med. 2016.