Ukuqwalaselwa ngokuSebenzayo, ukuPhepha, okanye iRadioation? Oko i-Studies Say
Ngenxa yokungabikho kwezifundo ezithelekiswa kakuhle, ukhetho lwonyango lwe- prostate lomdlavuza luye lwaphazamiseka kakhulu. Nangona kunjalo, ngo-Oktobha 2016, amanqaku amabini aqingqiweyo atyhicilelwe kwi-New England Journal of Medicine ebika ingxelo yeminyaka eyi-10 evela kumavolontiya angama-1,643 avumelekile ukuba athathwe ngokulandelelana (ngokubhekiselele ekutheni "utywala" uhlolo.
Isifundo sokuqala saqhathanisa iziphumo zokusinda iminyaka eyi-10, ngelixa isibini, isifundo somlingane, sisetyenziselwa imibuzo ngokuthelekisa umgangatho wokuphila komgangatho. Okokuqala, siza kuxubusha umbuzo wokuphila. Emva koko siza kuxubusha umgangatho wobomi obunempembelelo.
Ukubaluleka koCwangciso loPhando
Ukufumana amavolontiya ukuba athathe inxaxheba kwindlela yokwabiwa ngokuthe ngqo, kunokuba ukhethe unyango ngokwabo, kunzima ukuyifeza. Akumangalisi ukuba oku kuphela ukufundiswa okuye kwapapashwa kolu hlobo. Nangona kunjalo, ukurhoxiswa kwemali kubalulekile ukuqinisekisa ukuba izigulane kwiqela ngalinye labathathu ziyimpilo kwaye zinomdla ofanayo wesibeletho. Ngaphandle kwesiqinisekiso sobudlelwane phakathi kwamaqela, iziphumo zophando ziya kuzingathembekanga.
Ukuziqhathanisa neSifundo
Ixabiso eliphambili lokufunda ngokungaqhelekanga kukuba izigulane zentsholongwane zandula zifumana ulwazi oluchanileyo malunga nendlela ezintathu unyango oluqhelekileyo lusetyenziswa ngayo.
Nangona kunjalo, ukwenza ukuthelekiswa okuchanekileyo, iphrofayili yesigulane kufuneka ifane nezigulane ezithatha inxaxheba kwisifundo. Ngoko, makhe sihlolisise iprofayile yabathathi-nxaxheba. Iminyaka yabo isukela kuma-50 ukuya kuma-69, kunye nobudala obuphakathi kweminyaka engama-62. Umyinge we-PSA waba ngu-4.6. Kwesine-yesine yamadoda, ugqirha wayenokuva isigxina kwi-prostate ngomunwe wakhe.
Amadoda asithoba kwabayishumi ayenamanqanaba angama-PSA angaphantsi kweshumi (nangona kukho izigulana ezimbalwa ezinezinga le-PSA phakathi kwe-10 no-20). Amathathu anesine amadoda ayenayo iGleason 3 + 3 = 6., enye yesihlanu yayineGleason 7, kwaye omnye kumadoda angamashumi amahlanu abe neGleason izikolo ezi-8 ukuya kwi-10.
Ukubeka iliso nge-Surveillance esebenzayo
Ukubeka esweni nayiphi na into ebizwa ngokuthi "umhlaza" ihlala kakubi nezigulane kunye noogqirha ngokufanayo. Ingcamango entsha kunye nendlela yokuqhubeka ishintsha. Indlela yokubeka esweni kweli pho nonongo yayixhomekeke kuphela kwi- PSA . Ukusetyenziswa kwe-biopsies yokulandelelana okanye ukucinga nge-MRI ye-multiparametric akukhuthazelwanga okuqhelekanga ngemilinganiselo yanamhlanje. Ngaphezulu kweminyaka eyi-10 yocwaningo, phantse isiqingatha samadoda kwiqela lokuhlola lalihlinzwa okanye imisebe engaqhelekanga. Ifilosofi eyisiseko emva kokuqwalaselwa ngokunyanisekileyo kukubukela amadoda ngokusondeleyo, kwaye ukuba umhlaza ukhula, sebenzisa unyango olungaphaya ngaphambi kokuba umhlaza usasazeka.
Impembelelo Yonyango kuMsindisi
Uyilo oluphambili lwesifundo luyilokuba uphendule umbuzo omnye- wokuphila. Xa abantu beqala ukuva ukuba banomdlavuza, abaninzi banamacango malunga nendlela yokuphepha ukufa kwangaphambili. Ukuba ukusinda kukubalulekileyo, olu cwangciso luyabonisa ngokucacileyo ukuba indlela yokwelapha ayenzi mmahluko .
Kuzo zonke iindidi ezintathu, umphumo wawufana. Ipesenti e-1 kuphela yamadoda (inani eli-17 lamadoda) labulawa ngumhlaza wesibeletho kwiminyaka yokuqala eyi-10. Eli nani lincinane xa sicinga ukuba yintoni umphumo wawuya kwenzeka ukuba amadoda aphethe iGleason 7 kunye / okanye i-nodule eneempawu ayengabandakanywa kwisifundo. Kwiminyaka yokuqala eyi-10, kwakukho kuphela ukufa kwabathandathu kumadoda aphethe iGleason 6 kunye novavanyo oluqhelekileyo lwama-rectal (amadoda ayisithandathu ahanjiswa ngokufanayo kuwo onke amaqela amathathu). Impembelelo yonyango ekufeni, ubuncinane kwiminyaka yokuqala eyi-10, ibonakala ingenanto.
Kuthiwani Ngeemetastases?
Kodwa kuthekani emva kweminyaka eyi-10?
Lo awusona umbuzo ophakamileyo ophezulu kumadoda aphikisayo ama-70; Amadoda kuma-80s ayenokufa ngenxa yezizathu ezingahambelani. Kodwa ngokuqinisekileyo umbuzo ofanelekileyo kumadoda ase-50s. Uphononongo lubonisa ingozi ephakamileyo kakhulu yokuphuhlisa i-metastases kwiqela lamadoda ayenokubekwa kweliso xa kuthelekiswa nokuhlinzwa ngokukhawuleza okanye umbane. Ngokukodwa, amadoda angama-29 kuphela, abengu-13 ababenokuhlinzwa kunye nabangama-16, abahlala kunye ne-metastase emva kweminyaka eyi-10; ngelixa amadoda angama-33 kwi-surveillance ayenawo amayeza . Oku kubalwa kwi-3% yemingcipheko ephakamileyo yemetastases ngokubhekisana nokuqhathaniswa ngokukhawuleza okanye imitha. Akukho mfahluko omkhulu, kodwa ngokuqinisekileyo umphumo ukuba ungomnye wabantu abangenangqiqo kuma-3 ekhulwini.
Impembelelo yeMetrostases kwiNkulondolozo
Ekubeni ubuncinci ama-50 ekhulwini amadoda ahlakulela i-metastases ekugqibeleni aya kufa ngumhlaza wesibeletho, kubonakala ngathi, ngokolu cwaningo, ukuba amadoda athathwe ngokunyamekela aya kuba nezinga eliphezulu lokufa kwabantu (mhlawumbi 1 ukuya kwi-2 ekhulwini) kuvela kwiminyaka eyi-10 kuya kwe-20 emva kokuxilongwa, xa kuthelekiswa namadoda athotywayo ngokukhawuleza okanye kumbane. Nangona kunjalo, eli qiniso kufuneka lithathwe ngqolowa eninzi yetyuwa, becinga ukuba iindlela zokulanda ezisetyenzisiweyo ayinelanga ngemilinganiselo yanamhlanje. Njengoko kuphawuliwe ngasentla, la madoda ayebukele kuphela nge-PSA. Babengenako ukukhangela rhoqo nge- MRI ye-multiparametric , kwaye kwakungekho naluphi na uphando lwe-biopsies ezingahleliweyo ezenziwe ngokucwangcisiweyo. Ezi zi gulane zishiywe kakhulu kakhulu ukuzizimela. Ukuqwalasela le nqanaba elimangalisayo lokunyanzelwa, ukunyuka kwamaxabiso okunyuka kwama-3% ekhulwini kubonakala ngathi kuphantsi.
Uqwalaselo lweTheknoloji luye lwaphucula ngokukodwa
Kukho esinye isizathu esichukumisayo sokukholelwa ukuba izinga eliphezulu le-metastasis elichazwe kulolu phofu lugqithisa ingozi yokwenza uhlolo olusebenzayo. Iprofayili yamadoda ayangeniswa kulolu cwaningo ayilona uhlobo lwamadoda aqhelekileyo anconywa ukuba ahlolisise. Ingaphezulu kweyesine yamadoda kulolu cwaningo luneengqungquthela ze-Gleason ezi-7 okanye ngaphezulu, i-nodule ene-palpable efunyenwe kwi-digital rectal examination of prostate yabo, okanye zombini. Olu luhlobo olunefuthe olunefuthe lomfesane womhlaza kunokuba luvame ukucetyiswa ukuba kubekwe iliso.
Uphuculo lwezobuchwepheshe kunye noBucholo okanye i-Radiation?
Ngaphambi kokuba sishiye ingxoxo yethu yokusinda size siqhube phambili kwingxoxo yobomi bomi, ndona enye ingqalelo yokunikela. Ndayigxeka indlela yokufunda ngokuthembela kwi-PSA yokubeka iliso yodwa ngokungonelanga. Kodwa kuthekani ngamacandelo okuhlinzwa okanye amayeza? Ngaba singalindela izinga lokunyanga eliphezulu ngokusebenzisa i-teknoloji ye-2016 xa kuthelekiswa nento abantu abaye bafumana kulolu phofu? Impendulo emfutshane ayikho. Nangona uphando lwe-robotic ukuhlinzwa lubika ngokukhawuleza ukuphilisa, amazinga okunyanga kunye neerhafu zokufumana ulwabelana ngesondo kunye nokuhlaziywa kwamanzi aziphuculanga. Ngokubhekiselele kwimizila emzimbeni yangaphandle, imirhumo yonyango kunye nemiphumo emibi kunye ne-IMRT yanamhlanje iluhlu olufanayo.
Umgangatho woBomi beMicimbi ukuba ukuPhepha kuyinto efanayo
Ukuphinda uhlolisiso olusebenzayo kunengqiqo xa usichazwa ngomgangatho wobomi. Isizathu esisodwa sokuyeka unyango olusisiseko sinoxanduva olusisiseko sokuba umsebenzi wesiganeko wesondo kunye nokuvuthwa komzimba uya kuphazamiseka. Ukuba unyango aluzange lube nemiphumo emibi, wonke umntu unokufumana unyango; Amadoda angaqhubeka kunye nobomi bawo aze akhohlwe ngokubeka iliso ngaphaya kwe-PSA. Nangona kunjalo, makhe sikwazi ukujongana neengxaki ezichaphazelekayo zonyango, umngcipheko wobuthathaka kunye nokungabikho.
Imibuzo ngaphambi kokuba emva kweNyango
Kwisifundo somlingane ovavanya umgangatho wobomi, bonke abathathi-nxaxheba baxoxwa malunga nomsebenzi wabo wesondo kunye nokulawulwa kwamanzi ngaphambi kokunyanga, 6 kunye neenyanga ezili-12 emva kokunyanga, kwaye emva koko emva koko. Kulo mze keliso, utyando lwachongwa ngokulula njengeyona ndlela eyona nto ibaluleke kakhulu kwimpumelelo yobomi. Ngaphambi kokonyango, i-1 ekhulwini yamadoda yayingenalo ukungahambisani ne- urinary kwaye yayidinga ipads. Kodwa okwenyuka ukuya kuma-46 ekhulwini kwiinyanga ezi-6 emva kokuhlinzwa kwaye iphuculwe ngokukhawuleza kuma-17 ekhulwini kweminyaka engama-6 kamva. Kwiminyaka emithandathu emva kokuphuma kwemisebe ngakwelinye icala, iipesenti ezi-4 kuphela zamadoda zidinga ipasiti. Amaphesenti ayisishiyagalombili samadoda ekubhekisweni afunwa ipasiti (khumbula ukuba amadoda angama-50 ekhulwini ekuhloleni ngokukhawuleza atyathwa ngokukhawuleza okanye kumbane).
Impembelelo Yonyango kuMsebenzi Wezesondo
Ndicinga ukuba indlela echanekileyo yokunxibelelana neziphumo zophando malunga nomsebenzi wesondo / umphumo kukukunika isicatshulwa ngokuqondile kwisifundo:
"Kwinqanaba lokuqala, ama-67 ekhulwini lamadoda abika i-erections eqinile ngokwaneleyo yokulala kodwa ngeenyanga ezili-6 ezawela kuma-52 ekhulwini kwiqela elijongene nokunyamekela, ukuya kuma-22 ekhulwini kwiqela le-radiation kunye nama-12 ekhulwini kwiqela lokuhlinzwa. Umsebenzi we-Erectile wagcina ubi kakhulu kwiqela lokuhlinzwa ngamaxesha onke, kwaye nangona kukho ukubuyisela kuma-21 ekhulwini kwiminyaka emithathu, eli nqanaba lahla kwakhona kwi-17 ekhulwini kwi-6 iminyaka. Ireyithi kwiminyaka engama-6 ukuze iqela leemitha liyi-27 ekhulwini. Isilinganiso kwiqela lokubeka iliso lalingama-41 ekhulwini kwi-3 iminyaka kunye ne-30 ekhulwini ngonyaka 6. "
Nangona kuya kuba nokunciphisa ukungenakukugwema emsebenzini kwisini kwithuba la madoda asebekhulile, iziphumo zibonisa ukuba ukuhlinzwa kunempembelelo enkulu kunazo zonke kunokuba i-radiation okanye i-surveillance esebenzayo. Njengoko kuboniswe kwiphononongo, inxalenye yesithathu yamadoda kweli qela leminyaka sele ingenamandla phambi kokonyango. Ekubeni amadoda angaphaya kwamandla angenakukwazi ukungenako amandla emisebe, kunye nezinye iziphumo ezingathandekiyo zingabonakali, kubonakala ngathi akukho nto ikhuthaza ukukhusela i-radiation kwinqutyana yamadoda enokungaxhasi.
Izigqibo ezivela kulezi zifundo ezimbini
Okokuqala, amazinga okusinda kunye nokuhlola okusebenzayo alingana nokuhlinzwa ngokukhawuleza okanye ukukhanya kwemitha ukuya kwiminyaka eyi-10. Ukuqinisekisa ukukhusela kunye nokuphila kwamazinga angaphezu kweminyaka eyi-10, amadoda ecinga ngokubhekiseleka ngokukhawuleza kufuneka akhuphe ubukho naziphi na izifo zeBakala ze-Gleason ezi-7 okanye ngasentla kunye ne-MRI ye-multiparametric kwisiseko esilandelwayo. Okwesibini, izinga lokusinda kunye nemisebe ye-radiation lilingana nokuhlinzwa kodwa ngeyona mininzi imiphumo yesondo. Ngaphandle kweempembelelo zalo zesondo, i-radiation iyakunyamezela kakuhle. Ukuba unyango lubonakala luyimfuneko, imisebe yindlela engcono kakhulu yokunyanga umdlavuza weprotate kunokuba utyando.