Yintoni into eyikrakra kakhulu ngomhlaza? Kwabaninzi, ngumhlaza womhlaza unokubuyela emva kokuhlinzwa. Ngomdla we-cancers-colon, isifuba, ingqondo, i- melanoma , okanye imiphunga, ngokomzekelo-ezi zihlandlo ziphantse zifa. Umhlaza weprotate, nangona kunjalo, uhlukile. Unokufumana kunzima ukukholelwa, kodwa abantu abanezifo ezibuyiselwayo banokufa ngenxa yobudala kunomdlavuza wesibeletho.
Umhlaza weProstate uhlukile
Kutheni i-prostate isifo se-prostate sihluke kakhulu? Izizathu ezininzi. Okokuqala, ikhula kwaye isasazeka ngokuthe ngcembe kunezinye iintlobo zomhlaza. Okwesibini, imishanguzo engacwangcisi i-testosterone (i-hormonal blockade) iyanelisayo. Amadoda angena ekuxolelweni kwiminyaka eyi-10! Kodwa yintoni eyenza umhlaza wesifo se-prostate uyingqayizivele yindlela ekhethekileyo yeprotheni eveliswa kwi-prostate gland ebizwa ngokuba yi-prostate-specific antigen, enye eyaziwa njenge-PSA.
I-PSA iyamangalisa
Nangona ukulinganisa inani le-PSA egazini lomntu ukuba likhusele umhlaza sele libuzwa ngokungathandabuzekiyo, i-PSA yimiqathango yegolide yokufumana izifo eziphinda zibuyiselwe. Enyanisweni, ezinye iintlobo zesifo somhlaza azikho nto ezize zifikelele ekuchanekeni kwe-PSA. I-PSA ibona umdlavuza omncinci . Ngelishwa, ezinye i-cancer ziyakwazi ukufunyanwa kuphela ngeesisombululo, emva kokuba izicubu eziphindaphindiweyo zibe zikhulu ngokwaneleyo ukuba zibonwe ngeso iso.
Ukuze iimvumi ziboniswe kwi-scan, kufuneka zibe ngaphezu kwesiqingatha-intshi ububanzi kwaye ziqule ubuncinane iiseli zomhlaza zesigidi esisodwa . Uvavanyo lwegazi lwe-PSA, ngakolunye uhlangothi, lubona ukuphindaphindwa kunye namancinci angama-100,000 amaseli.
Ixesha le-PSA lokuPhikisa lichanekile ngakumbi kuneGleason Score
Ukuqwalasela ukuphindaphinda kunye ne-PSA kwisigaba sokuqala esona sikwazi ukudala ithuba lokujonga ubunzulu bokuphindaphinda.
Ngokuphindaphindiweyo, ukuhlolwa okulandelelanayo kwe-PSA-kuthetha ngegazi leenyanga-ireyithi yokunyuka kwe-PSA ingachongwa ngokuchanekileyo. Kwenzeka ngokukhawuleza ukuba ii-PSA zibini zityhila ibakala lokuphindaphinda. Le ngcaciso ibaluleke kakhulu kuba ukuhlaziywa kwamabanga aphantsi kuya kunyangwa ngokugqithisileyo kunokuba uphinde ubuyekelele.
Uninzi lwabantu baqhelana neenkqubo zokubamba iGleason, indlela eyaziwayo kakhulu yomdlavuza ebantwini abasandul 'ukuvavanywa , oko kukuthi, ngaphambi kokubuya kwakhona. Ngeenkqubo zeGleason, iiseli zomhlaza zixhaswa ngugqirha othethekileyo obizwa ngokuba ngu-pathologist. I-pathologist ibona i-specimen ye- biopsy phantsi kwe-microscope kwaye ibeka ibakala kumhlaza . Isistim seGleason sisona sibonakaliso esinamandla kunazo zonke sokubamba umdlavuza wesifo somhlaza wesandulululo kwaye sinendima ebalulekileyo ekuqaliseni unyango olungcono kumadoda asanda kufunyanwa. Nangona kunjalo, kumhlaza wesibeletho obuye waphinda, i-PSA ixesha eliphindwe kabini ligqithisa ngokuchanekileyo ukuchaneka kwinqanaba leGleason. Ukwazisa ngesantya sokukhula komhlaza kuyona ndlela echanekileyo yokumisela ukutshatyalaliswa komhlaza, kwaye, ngenhlanhla, i-PSA igqiba oku ngokungenakulinganiseki.
Xa ixesha le-PSA eliphindwe kabini libonisa ubunzima bokuphindaphinda, isicwangciso sonyango senziwa.
Unyango luyahluka kakhulu kuxhomekeke kwibakala lokuphindaphinda, ngoko ke uhlobo olululo lwezonyango kwi-bakala ngalinye lokuphindaphinda luxutyushwa ngezantsi.
Ukubuyela kwiBakala eliphantsi
Ngeenjongo ezichazayo, amabakala ahlukeneyo aphindaphindiweyo angachazwa: aphantsi, aphakathi, aphakamileyo. Ukwazi ibanga lokuphindaphinda liyisiseko sokhetho lwonyango. Ezinye zibuyela kwakhona, umzekelo, zinezinga eliphantsi kangangokuba akukho nonyango luya kufuneka. Oku kwenzeka xa iPSA idinga ngaphezu konyaka ukuphinda kabini. Xa ixesha eliphindwe kabini le linyameko, indlela efanelekileyo kukugweba unyango kwaye uqhubeke nokubeka i-PSA rhoqo emva kweenyanga ezintathu ukuya ezintandathu.
Uninzi lwezi gulane luhlala lukhutshwa ngoncedo ngonaphakade.
I-Intermediate-Grade Relapse
Xa amadoda anamaxesha e-PSA aphindwe kabini anesiphelo, tshilela kwiinyanga ezintandathu ukuya kwezi-12, bahlala bebaviwa kubahlobo lonyango. Ngokomlando, unyango luye lwaba yimpumpo eyimfama kummandla womzimba apho iprotrate yayisisithuba ngaphambi kokususwa kwayo. Ummandla ojoliswe kuwo ubizwa ngokuba yi-prostate fossa. Ngamanye amaxesha i-radiation esetyenziswe kule fashoni iya kuba yonyango. Izifundo zibonisa ukuba amazinga okunyanga ayenomsebenzi xa i-radiation iqaliswa ngaphambi kokuba i-PSA iphakame ngaphezu kwe-0.5. Njengaye ezininzi iintlobo zonyango lomhlaza, unyango lwangaphambili luqaliswe ngcono.
Unyango lweHormonal
Ukuba i-radiation ayiphumelelanga, unyango lwe-hormonal ngumgca olandelayo wokukhusela. Indlela eqhelekileyo kukuba ukhethe i-arhente ukusuka kwiluhlu olude lwama-hormone esebenzayo angasebenziyo okanye angalinganiyo-Lupron, Trelstar, Eligard, Firmagon, okanye iZoladex. La mayeza ajoyiweyo aqhutyelwa njengendlela yokulondoloza xa i-radiation ihluleka ukulawula iPSA ekhulayo. Iiseli zomhlaza zeprostate zidinga ukuba i-testosterone iphile, kwaye la mayeza asebenza ngokunciphisa i-testosterone. Ukulahla iiseli zomhlaza we testosterone kubangela ukuba bafe. I-hormonal blockade yenza ukuba kubekho umgangatho oqhubekayo we-antiticancer ogcinwe kumyinge weminyaka eyi-10, ecinga ukuba unyango luqaliswe kusasa, oko kukuthi, ngaphambi kokuqala kweetasastases. Ubunzima bokulawulwa kwezifo bufutshane kakhulu ukuba umdlavuza weprotate uvunyelwe ukuba uphumelele kumathambo ngaphambi kokuba uqaliswe unyango.
Unyango olungapheliyo
Ukunciphisa imiphumo emibi evela kwi-testosterone ephantsi, iiholide zonyango ngamaxesha amaninzi zicetyiswa. Indlela eqhelekileyo yokulawula i-Lupron kwiinyanga ezintandathu ukuya kwezi-sibhozo uze uthathe ieholide. Ngokuqhelekileyo i-PSA yehla ukuya ngaphantsi kwe-0.1 kwiinyanga ezintandathu zokuqala unyango. Emva kokuba imithi igqitywe kwaye iimpembelelo zayo ziphelile, i-testosterone ibuyisela ngokukhawuleza kwaye i-PSA iqala ukunyuka. Umjikelezo wesibini we-Lupron uqaliswa xa i-PSA iphakanyiswa kwisibalo esicacisiwe, sithi phakathi kwamathathu anesithandathu. Uphononongo lubonisa ukuba le ndlela ephakathi ilawula kakuhle umdlavuza kunye nokuba i-Lupron inikezwa ngokuqhubekayo.
Uhlobo lwe-Hormone Treatment
Ngamanye amaxesha, iifom zomlomo ze-hormone unyango ezifana neCasodex (bicalutamide), kunye okanye ngaphandle kwe-Avodart (i-dutesteride), inokufakwa endaweni yeLupron ukwenzela ukunciphisa imiphumo emibi. Olu hlobo lendlela lungahle lukhethwe, umzekelo, kwizigulane ezisebekhulile okanye i-frailer. Iziphumo eziqhelekileyo ezichaphazelekayo ezinxulumene neentlobo eziqhelekileyo ezinokusetyenziswa kweyonyango-ukukhathala, ubuthathaka kunye nokunyuka kwesisindo-ziba nzima kakhulu. Nangona kunjalo, kukho umphumo omnye wecala oqhelekileyo ngokukhula kwe-Casodex-breast. Le ngxaki, nangona kunjalo, ingaxhatshazwa nepilisi yokuvimbela i-estrogen ebizwa ngokuthi yi-Femara. Ngaphandle koko, iqondo elimodareyithwa elisezantsi elibhekiselele kwingxube ngaphambi kokuba iCasodex iqalwe ngokuqhelekileyo ivimbela ukwandiswa kwebele.
Ukunyanga ukuPhinda kweBanga eliPhakamileyo
Amadoda aphethwe ngumhlaza womhlaza wesifo seprotate apho i-PSA ixesha eliphindwe kabini lingaphantsi kweenyanga ezintandathu lijongene nemeko engakumbi. Ukuba eso sifo asigcinwanga ngqalelo ngonyango osebenzayo, umhlaza unokusasazeka ngokukhawuleza kwaye ube usongelo lobomi. Nayi, indlela yokunyango efanelekileyo kakhulu kukufumana isicwangciso esinobudlova esithembele kwiinkqubo zonyango ezinikezwe ngexesha elifanayo, i-aka indlela eyahlukeneyo. Intsalela yeli nqaku iya kujongana nokunyangwa kwe-grade-grade relapses.
Iimpawu ze-Art-of-the-Art
Isinyathelo sokuqala kukusebenzisa iteknoloji yokukhangela ngokufanelekileyo ukucacisa apho emzimbeni umdlavuza ukhona khona. Okwangoku, i-lymph node ebonakalayo ihamba phambili (i-lymph node iindawo zokuqala ze-metastases) zi-C 11 Acetate okanye C 11 i- Choline PET. Ngelishwa, eUnited States ezi ziko zifumaneka kuphela kwi-Phoenix Molecular okanye kwi-Clinical Mayo. Kungekudala, uhlobo olutsha lwe-PET olubizwa ngokuba ngu- Axumin luye lwafumaneka ngokubanzi. Izifundo ezithelekisa ukuchaneka ngokuchanekileyo kweAxumin kunye neC 11 PET ziyaqhubeka. Enye, uhlobo olutsha lwe-PET scan ebizwa ngokuthi i-Gallium 68 PSMA ngoku ingena kwizilingo zamachiza kumaziko ahlukeneyo ase-US.
Ukongeza kwi-lymph nodes, ukuqhubela phambili umdlavuza we-prostate uhlala usasazeka emathanjeni. Ukubaluleka kwezicatshulwa ezichanekileyo ukufumanisa izifo zakuqala akunakugqithiswa. Kutshanje, ubuchwepheshe be-scan scan buye buphuculwa kakhulu kunye nokusetyenziswa kwetheknoloji entsha ye- 18 ye- PET. Nxa kunokwenzeka, i-F 18 PET i-scans i-scans ifanele isetyenziswe endaweni ye-Technisium 99 . I-PET yokujonga umdlavuza weprotate yintuthuko entsha yenguqu, eyenza oogqirha basebenzise imilayezo enokuphefumula ngendlela ephilileyo.
I-Radiation Plus I-Lupron Plus Casodex
Xa ubukhulu besifo sele luchongiwe ngokuchaneka ngokuchanekileyo, ukucinga ukuba inani leemastastas lilinganiselwe, (ungabi ngaphezu kwamahlanu), isinyathelo sokuqala ukuba uqalise unyango kunye neLupron kunye neCasodex kunye nesicwangciso sokuqhubela phambili ubuncinane unyaka. Ngokuqhelekileyo, iinyanga ezimbalwa emva kokuqala i-Lupron, i-radiation ilawulwa kwiindawo ezikhoyo eziza kuthiwa zifunyenwe ngokuskena) kunye neyonyango "yempumpo" yonyango kwi-prostate fossa nakwi "lymph nodes" eziqhelekileyo. Le mimandla yomzimba iyaphathwa ngenxa yokuba yindawo eqhelekileyo yokufumana izifo ezincinci, kwaye kunye neengxaki ze-PET zanamhlanje zingakwazi ukufumana umhlaza apha.
Izifo zeMicroscopic ngaphandle kweNdawo yeMithayo
Izifundo zibonisa ngokucacileyo ukuba xa i-radiation ijoliswa kwiindawo eziyaziwayo zesifo, ukutshabalalisa komhlaza kulawo masayithi kufuthi kufumaneke. Ngoko, ukungaphumeleli kwonyango ngokuqhelekileyo kuhambelana nemilinganiselo encinci yeesifo ezincinci kwezinye iindawo zomzimba ezingakhange zifumaneke, naphezu kobuchwephesha obuchwephezayo obubonakalayo. Ngoko ke, xa sisebenzisana nalezi zixhobo ezinobungozi zesifo somhlaza wesifo seprotate esinexesha elinokukhawuleza ngokuphindaphindiweyo, kusetyenziswa isicwangciso esinamandla esisebenzayo imishanguzo yenkqubo eyenziwa ngumntu wonke umzimba owenza yonke ingqiqo. Njengoko sele sele kuphawuliwe ngasentla, unyango lwe-antiticancer lusetyenziswa kakhulu xa luqala unyango kwinqanaba eliphambili, ngelixa isifo sisasenomzimba.
Iimithi ezininzi zokuphelisa izifo ezincinci
Ekubeni i-Lupron neCasodex ingaba ngabadlali abanjalo kwimidlalo yokonyango, abanye banokuzibuza ukuba ngaba ezinye iintlobo zemithi yokwelapha i-antiticancer ikhona. Xa umbuzo uhlelwe ngale ndlela, imithi emibili ivele ingqondweni, iZytiga kunye neXtandi. La maqumrhu anamandla abonise ukuphumelela kwe-antiticancer nangona xa unyanga abantu abanomdlavuza oye waxhathisa uLupron! Ukuqwalasela ukuba zilungelelanisa izalathisi zomlomo ngeprofayili yempembelelo ephathekayo, kunengqiqo ukuqwalasela i-Zytiga okanye i-Xtandi yeCasodex.
Kuthiwani Ngokuphathelene neKhemotherapy?
Ukongezelela kokusebenzisa udibaniso lwamachiza, njengoko kwakunjalo indlela echazwe kumhlathi odlulileyo, iingxelo zibonisa ukuba ukongezwa kwe- chemotherapy kunye neyeza elithi Taxotere linakho ukuphucula uphuculo. Nangona ezi zigqibo ziphambili, uphando lokuhlola ukuhlanganiswa kwe-Taxotere kunye no-Xtandi okanye iZytiga kubonisa ukuba le ndlela inokwenzeka.
Isiphelo
Amadoda aphethwe ngumhlaza wesibeletho emva kokuhlinzwa angakwazi ukufumana ubungakanani obufanayo-yonke indlela yokwelashwa. Xa ixesha le-PSA eliphindwe kabini lincinci, amadoda angabonwa ngokuphepha. Xa i-PSA yexesha eliphindwe kabini liye likhawuleza, i-radiation, i-Lupron, okanye zombini iyakwazi ukukhusela ngokuqhubekayo ukukhula kwesifo iminyaka engaphezu kwe-10. Amadoda aphinde ahlaselwe ngokugqithisileyo abonakaliswe ngethuba eliphinda ngokukhawuleza le-PSA kufuneka aqikelele ngokugqithiseleyo ukuqaliswa kokukhawuleza kweendlela ezininzi zokudibanisa.
> Imithombo:
> Kishan AU et al. Iziphumo zezonyango zezigulane ezineGleason 9-10 i-prostate adenocarcinoma ephathwa nge-radiotherapy okanye i-prostatectomy enkulu: Uhlalutyo oluninzi lweziko. Urology yaseYurophu . 71.5: 766, 2017.
> Nabid A et al. Ixesha le-androgen yokunyanzelwa kolwaphulo lomhlaza wesibeletho esichengeni ingozi: Isilingo esingahleliyo. Umbhalo we-Clinical Oncology. 31.18 i-suppl: LBA4510, 2013.
> Sandblom G et al. I-Positron ukuphuma kwe-tomography kunye ne-C11-acetate yokufumanisa i-tumor kunye neendawo ezikhoyo kwizigulane ezine-prostate-specific antigen ephindwe emva kwe-prostatectomy enkulu. Urology . 67.5: 996, 2006.
> Scholz M et al. Ukuvavanya kwakhona kwe-gm-csf, i-dose ephantsi e-cyclophosphamide, kunye ne-celecoxib kwixesha le-psa eliphindwe kabini (dt) kumadoda anomhlaza wesibeleko kunye ne-psa kwakhona emva kokuhlinzwa okanye imisebe. Umbhalo we-Clinical Oncology . 28.10 i-suppl: abstr e15061, 2010.