Indawo esetshenziselwa isifo se- prostate gland , esingaphakathi kwamamitha ayisithupha kwesikhumba nesigcawu, kusho ukuthi ama-urologists akakwazi ukusika umkhawulo omkhulu nxazonke. Ukufakelwa kwesinye isisu noma i-rectum akuyona inketho. Ngeshwa, uma umdlavuza wesiguli ukhula ngokusebenzisa i-capsule, kunokuba ahlasele umdlavuza, udokotela ohlinzayo uzophoqeleka ukuba aphephe umdlavuza ngesikhathi ezama ukukhipha igciwane.
Uma kwenzeka lokhu kubizwa ngokuthi "umkhawulo omuhle."
Ukushiya umdlavuza ngemuva kokuqinisekile kuhluleka okubi. Ngempela, uma umdlavuza ungasuswa ngokuphelele, kungani usebenza? Okuyiqiniso ukuthi ngaphambi kokuhlinzwa kukhona ukungaqiniseki njalo ngesilinganiso somdlavuza. Ngesikhathi sokuhlinzwa, isifo esincane kakhulu esingaphandle kwe-prostate ayibonakali iso. Khumbula, ubuciko bokususwa kwe-prostate kwakusungulwa ngenkathi yangaphambilini lapho wonke amantombazane ayebhekwa njengokusongela impilo nokuhlinzwa kwakuwukuphela kokukhetha okukhona. Emuva ngaleso sikhathi, ubuchwepheshe bokushisa imisebe kwakungenasisekelo. Amazinga okuguqulwa ayephansi kakhulu ngemisebe kanye nemiphumela emibi kakhulu eyingozi.
Ukucabangela kwansuku zonke nge- 3T ye-MRI multiparametric eyenziwa ngaphambi kokuhlinzwa, ngenkathi ingaphelele, inamandla okuthuthukisa ukuhlela ukuhlinzwa kakhulu. Ngeshwa, kuphela abambalwa bamadoda angu-70 000 abahlinzwa njalo ngonyaka ngokuzuza ukuskena ukuhlela ukuhlinzwa ngaphambi kokwenza umsebenzi.
Sethemba, le nqubomgomo izoshintsha.
Ngenxa yezimo ezithintekayo ezichazwe ngenhla, umdlavuza, ngokwesilinganiso, ushiywe ngemuva emzimbeni wesiguli noma kuphi kusukela kumaphesenti angu-10 ukuya kwangu-50 yesikhathi. Umkhawulo omuhle kuqala uthola ukunakekelwa kwesiguli ezinsukwini ezimbalwa emva kokusebenza. Ngemva kokususwa, i-prostate ihlaziywa ebhokisatri ngudokotela owaziwa ngokuthi i-pathologist.
I-prostate ilungiselelwe ukuhlolwa okuncane kakhulu ngokuyibeka ebhodleleni leyinki ukuze yonke ingqimba yengaphandle igcwake. Khona-ke igundane lisikiwe ngokuzenzekelayo ezindaweni eziyincithakalo ngokuqapha okukhethekile okukhokhwa endaweni yegland lapho umdlavuza ukhona khona. I-pathologist inikeza ukunakwa okukhethekile emaphethelweni endlala ngokuyibeka ngaphansi kwe-microscope. Uma i-tumor ibhekwa "ihlaselwa" ngokumelene ne-inkin, lokho kusho ukuthi i-scalpel yokuhlinza inqunywe ngesisu ngesikhathi sokuhlinzwa, ishiya isidumbu ngemuva komzimba wesiguli.
Ukuba khona komkhawulo omuhle kungaba okungathí sina ngokweqile kuye ngokuthi yi- Gleason score kanye nobubanzi bezimpawu ezinhle. Ngaphakathi kwebhodi, ingozi enkulu yomdlavuza wesikhathi esizayo ibuyele emadodeni anemigqa emihle ingamaphesenti angama-50. Kodwa-ke, uma isiqephu seGleason siphezulu noma uma ama-margins ahle kakhulu, ingozi yokuphindaphinda esikhathini esizayo ingafinyelela ezingamaphesenti angu-100.
Ukwelashwa Okuqhubekayo Uma Amanqamuzana Enamandla
Ukunquma ukwelashwa okuqhubekayo ngemva kokuhlinzwa uma ama-margins enhle kungaba yinselele. Enye indlela ukugcina nje isimo ngenkathi kuqapha amazinga e-PSA eduze. Le ndlela ikhangisa kakhulu uma isiqephu seGleason sisezingeni eliphansi futhi elincane kakhulu.
Amadoda asele ekuxoxweni angakugwema imiphumela yecala ehlobene nokwelashwa esuka emisebeni yonke. Futhi, kule nkathi yokuthuthuka kwezobuchwepheshe, amadoda awela ukuphuza ukwelashwa kweminyaka ephakeme ye-PSA phansi komgwaqo angase abe nomkhulu esikhathini sokuthi ukwelashwa okuthuthukisiwe okungenobuthi obukhulu futhi obuphumelele kakhulu.
Kwabesilisa abanquma ukuphishekela ukubuka, ukuqapha kwe-PSA kufanele kwenziwe ngebuchwepheshe obunamandla. Khona-ke, uma i-PSA ikhuphuka, ukwelashwa kungaqaliswa ekuqaleni, lapho i-PSA isengaphansi kuka-0.1. Amazinga okuphulukisa ngokuqinisekile aycono kakhulu uma ukwelashwa kuqalwa ezingeni eliphansi le-PSA.
Lapho ama-margins ehlinzayo ehle, izifundo eziningana zibonisa ukuthi ama-radiation ngokushesha ku-prostate fossa ayokwehlisa izinga lokuphindaphinda futhi anganciphisa kancane izinga lokusinda iminyaka eyishumi. Kodwa-ke, njengoba kuphela amadoda angama-50% azobuyela emuva, ukulinda ubufakazi bokuphakama kwe-PSA ngaphambi kokuqala imisebe kungase kube okunye okunengqondo. Ngokuvamile, inqubo yokuqapha iqukethe ukuhlola i-PSA njalo ezinyangeni ezintathu. I-radiation iqala uma i-PSA ikhuphuka ngaphezu kuka-0.1 noma 0.2.
I-radiation iyindlela yokwelashwa evame kakhulu yokuphathwa kwendawo yokubuyela emuva ngemuva kokuhlinzwa. Nakuba imisebe ivame ukuphumelela, kungenzeka ukuthi izinto ezincane ezincane ezingaphansi kwe-prostate fossa kwenye indawo yomzimba zidinga ukucatshangelwa. Ukushiswa kwe-fossa yedwa ngeke kube nokwelapheka uma isifo sesakazeke. Ngeshwa, ukuzimisela kokugcina mayelana nokutholakala noma ukungabikho kwamathambo ayisimangaliso akukwazi neze ukuqiniseka. Awekho ubuchwepheshe obubona ngokugcwele izifo ezincane ngamaphesenti angu-100 ngokunemba.
Ochwepheshe abanokuhlangenwe nakho baye bafunda ngokuhlangenwe nakho ukuthi ama-metastases amancane angase abe khona lapho amaphuzu weGleason ephakeme futhi lapho ama-margins asebenza kahle ephakeme kakhulu. Kulezi zimo, insimu ye-radiation kufanele isandiswe ukuze igubungele ama-lymph nodes. Ukwelashwa kwamahomoni noLupron kuvame ukuphakanyiswa.
Amanqamu Amandla Ahlukahlukene
Ukuqapha umdlavuza we-prostate ngaphandle kokwelapha ngokushesha akufanelekile amadoda anezikhala eziningi ezihle. Amaningi amaningi ngokuvamile asho ukuthi umdlavuza wokuqala wawukhulu futhi ubanga eliphezulu. Uhlelo lokuqapha kulesi simo alufanelekile ngoba umdlavuza odlayo uzoba njalo njalo. Ukuphuza ukwelashwa kuvumela nje isikhathi esengeziwe sokuba umdlavuza ukhule futhi usakaze.
Amadoda anama-margins amaningi emva kokuhlinzwa kufanele aphathwe ngendlela yokwelashwa kwe-multimodality ehlanganisa imisebe, ukwelashwa kwe-hormone mhlawumbe ngisho ne-chemotherapy. Ngokuyinhloko, sekuyisikhathi sokwenza umlutha, umzamo wokugcina ukwelapha lesi sifo. Kukhona ukuhlukahluka okukhulu phakathi kochwepheshe ngokuqondene nenqubo efanele yokunconywa. Kodwa-ke, ngokuvamile, izinhlelo zokwelashwa zivame ukulinganisa indlela izingozi eziphezulu ezitholakale ziphethwe ngayo (bheka ngezansi). Izinhlelo zokuphenya nazo zibheke ekungezeni ama-hormone ama-hormone anamandla anjenge-Xtandi noma iZytiga noma ukwengezwa kwemikhakha ye-chemotherapy engu-4 kuya ku-6 ne-Taxotere ukuze ubone ukuthi amanani okuphulukisa angaphumelela yini.
Kungumqondo omuhle ukulinda izinyanga ezimbalwa emva kokuhlinzwa ngaphambi kokuqala ukwelashwa. Lokhu kunikeza isikhathi sokuphulukisa futhi ngethemba lokuthi kuzovumela ukubuyiswa kokulawulwa kwamanzi ngaphambi kokuqala ukwelashwa. Ukwephuza okuqhubekayo, ngethemba lokuthi umsebenzi we-erectile uzoqala, inqubo engadinga iminyaka emibili, ngokuvamile ayihlakaniphile. Ukucabanga ukuthi akubanga nezezinkinga ezingalindelekile, ukwelashwa kwe-hormone ne-Lupron ne-Casodex kuqalwe futhi kwaqhubeka izinyanga ezingu-12-18. Ukubonisana nesipiliyoni somsakazo we-radiation, onolwazi lokuphatha i-lymph nodes ye-pelvic, iyatholakala.
Iseluleko esivamile samadoda anama-margins amaningi, ukuqala ukwelashwa kwemisebe okuqondiswa i-prostate fossa kanye nama-lymph nodes we-pelvic. Ama-node we-pelvic yiwona oqaqa phambili emkhakheni womdlavuza uma uzosabalalisa. Imisebe iqala cishe izinsuku ezingu-60 emva kokuqaliswa kwe-Lupron ne-Casodex. (I-hormone therapy ihlotshaniswa nemiphumela emibi engaba khona, ezinye zazo zinganciphisa ngemithi, ukudla nokuzivocavoca.) Ngikisela ukuthi bonke abantu bacabange ukufunda isihloko engibhalile ngalesi sihloko.
Ngemuva kokuba kuqedwe imishanguzo ne-hormone therapy, kudingekile ukubhekwa okuqhubekayo. I-Testosterone ne-PSA amazinga ahlolwe njalo emva kwezinyanga ezintathu iminyaka emibili, njalo njalo ezinyangeni eziyisithupha iminyaka emithathu ezayo. Ukuqapha kwe-Testosterone kungayeka uma amazinga avamile elula. Bonke abantu abaye baba nemisebe, ngisho nalabo abaphulukisiwe, bayodinga ukuqapha kwonyaka yonke ngenxa yengozi yezicubu ezincane ezithwala imishanguzo yesibindi noma i-rectum. Ngenkathi lezi zinhlobo zezinambuzane zingavamile, ukutholakala kokuqala kuholela ekwelapheni okuncane kakhulu, okusebenza kahle.