Njalo ngonyaka ama-urologists angu-15 000 avela emhlabeni wonke aya emhlanganweni we-American Urology Association (AUA) waminyaka yonke ukuze abonise ukutholakala kwawo kwamuva kusukela ocwaningweni oluqhubekayo lwezokwelapha futhi abelane ngokuphumelela kwamuva komdlavuza we-prostate. Umcimbi kaMeyi 2017 ubonakalise intuthuko ekulandeleni ezinye izindlela ezibhekene ne-12-core random needle biopsy ye-prostate.
Lapha, sizoxoxa ngezinhlobo ezimbili zalezi zindlela ezintsha-i-OPKO 4k test test kanye ne-3T multiparametric MRI (MP-MRI). Bobabili ngokuphumelelayo banciphisa isidingo sokusebenzisa i-biopsy eyi-12 ephakathi kokungahleliwe.
Amadoda angaphezu kwesigidi ahamba nge-biopsy engama-12 okungahleliwe unyaka ngamunye. Le nqubo ibangela izifo ezimbi, ukungabi namandla, nezinye izinkinga. Okubi nakakhulu, kubangelwa ukuxilongwa okungadingekile komdlavuza wesibeletho seBanga 6 kumadoda angaphezu kuka-100 000 ngonyaka; eminyakeni eyishumi edlule, ochwepheshe baye bafunda ukuthi iBanga 6 akukaze libhekwe njengomdlavuza kuqala , njengoba lingenalo amandla emitha. Noma kunjalo, ngemuva kokutholakala ukuthi unamaBanga 6-cishe njalo njengomphumela we-12-core okungahleliwe we-biopsy-up of amadoda angu-50,000 ngonyaka uhlinzeka ngokuhlinzwa okukhulu noma imisebe yokuphatha lesi simo esingenabungozi. Kulula ukubona ukuthi kungani ezinye izindlela ze-biopsy ezingu-12 zizuzisa futhi zijabulisa.
Izinzuzo Zesivivinyo Segazi Esilula
Esikhathini isethulo ngo-2017 AUA, uDkt. Stephen Freedland waseCedars Sinai eLos Angeles wakhuluma ngekhono lokuhlolwa kwegazi le-OPKO 4K ukubikezela ukuthi umdlavuza ophawulekayo we-prostate (CSC) uyakulinganisa. Lokhu kuchazwa ngokuthi umdlavuza we-Gleason 7 noma ngaphezulu , uhlobo lomdlavuza wesifo sofuba oludinga ukwelashwa.
Yena kanye nabaphenyi bakhe baqhathanisa ukuhlolwa kwe-OPKO ku-PSA algorithm ejwayelekile eyenziwe yizinye izici ezibalulekile zokubikezela ezifana nobudala besiguli kanye nokuhlolwa kwe-digital rectal.
Icala labandakanya amadoda angu-366 kanye nokuhlolwa kwe-OPKO kuboniswe ukuze kutholakale ukuthuthukiswa okuphawulekayo kokunemba ngokwe-algorithm ye-PSA yokubikezela i-CSC. Ukuhlolwa kwakutholakala ukuthi kunembile kumadoda ase-Afrika aseMelika (isibalo esiphezulu sezwe somdlavuza wesicathulo). Njengoba kuhlolwa okulula kwegazi, i-OPKO iyisinyathelo sokuqala esiqondakalayo sokuhlolwa kwamadoda angatholakali namazinga e-PSA ngaphezu kwebanga elijwayelekile leminyaka yabo.
Ukuthuthukiswa kokufanekisa kwe-Prostate
Ngokomlando, ukuhlolwa kwe-prostate kwakungalungile kakhulu. Ngisho namanje, ukuskena kusha kakhulu ukuthi ukuxilongwa komdlavuza wesifo sofuba kuncike kakhulu kwi-biopsy engama-12 okungahleliwe. Yingakho i-imaging ingenye yezindawo ezishisa kakhulu futhi eziphuthumayo kakhulu zocwaningo lomdlavuza we-prostate.
Kunezici eziningana zokuguqula ukucabanga nge-MRI multiparametric (MP-MRI):
- I-MP-MRI, esikhundleni se-biopsy engahleliwe, ingaba isinyathelo sokuqala sokuxilonga. Iskena esenziwe kuqala esisezingeni eliphakeme kakhulu linembile kunokwakheka kwe-biopsy okungahleliwe yokuthola umdlavuza ophawulekayo emtholampilo.
- Uma ukuskena kuthatha ukungavamile, i-biopsies yesaliti ingaqondiswa ngqo ku-tumor engase ibe khona usebenzisa inombolo elinganiselwe ye-biopsies ehlosiwe. Uma umdlavuza ukhona, ulwazi mayelana nebanga leGleason linembile kakhulu.
- Ukunqunywa kwesigaba somdlavuza kunembile kakhulu. Isibonelo, ukuhlasela komdlavuza we-vesicle ye-seminal (ngaphandle kwe-gland) kulula kakhulu ukubona yi-MP-MRI kunokuba ne-biopsy engahleliwe.
- Amadoda anomdlavuza wezinga eliphansi, abaye banquma ukuqapha isimo sabo ngokubhekwa ngokucophelela, babe nokunye kokusebenzisa i-MP-MRI kunokuba benze ama-biopsies angama-12 asemqoka ngokuqhubekayo nangokuqhubekayo.
Enye yezinto ezibaluleke kakhulu emkhakheni we-prostate imaging kuye kwaba ukuthuthukiswa kwendlela yokufanisa ukulinganisa amabala angavamile (okungaziwa ngokuthi "izilonda"). Ukubikwa kwe-Prostate Imaging Reporting kanye ne-Data System (PI-RADS), ethandwa kakhulu kunazo zonke, ama-grade lesions ngesilinganiso esisodwa kuya kweyisihlanu. Iziguli kufanele ziqaphele ukuthi lesi simiso sisha, kanti odokotela abafunda lezi zicucu basalokhu befunda ukuthi bangasebenzisa kanjani i-PI-RADS ngenzuzo enkulu kakhulu.
Odokotela uPeter Pinto noPeter Choyke abavela kwiNational Cancer Institute babikezela ngokunemba kwe-PI-RADS ngokuthola umdlavuza ophawulekayo wesifo sofuba (CSC), ophinde wachazwa ngokuthi iGleason 7 noma ngaphezulu. Bahlola iziguli ezingama-339 ezaba i-MP-MRI. Izilonda ezingavamile zahlolwa ngokuqhuba i-biopsy ehlosiwe. Ngenkathi izilonda ze-PI-RADS ezingeni le-5 zishintshwa, i-CSC yafunyanwa ngamaphesenti angama-72 esikhathi. Kodwa-ke, kuphela amaphesenti angu-22 ama-PI-RADS 4 izilonda, amaphesenti angu-12 ama-PI-RADS 3 izilonda kanye namaphesenti angu-10 e-PI-RADS 2 izilonda ezibonisa i-CSC.
Ngokusekelwe kulolu lwazi olutholakala esikhungweni esihamba phambili sobuhle, kubonakala kunengqondo ukucubungula ukwenza i-biopsy ehlosiwe yamadoda anezilonda ze-PI-RADS 4 no-5 nokumane uqapha amadoda ngokuphinda i-MP-MRI ezinyangeni ezingu-6 kuya kwezingu-12 uma i-PI -RADS 1, 2, noma i-3 lesion itholakele.
Yeka ukuthi Ziyiqiniso Kangakanani Lezi Zisithombe?
Ngokusho kocwaningo olungeziwe ohlelweni lwe-PI-RADS lokufunda i-MP-MRI, eyabhalwa uDkt. Gerald Andriole nabanye, isabelo esifanele sePI-RADS score by radiologists abaqeqeshiwe sidinga talent innate, hhayi nje isipiliyoni. Imiphumela enembile ayixhomeke ekuhlangenwe nakho okude nokufunda izikrini. Kulolu cwaningo, abacwaningi babheka ukunemba kwe-PI-RADS ukufunda okuvela kuma radiologists amane okuhlangenwe nakho okuhlukile futhi bathola ukuthi ukunemba akuzange kwenziwe ngcono ngokuhlangenwe nakho okukhulu.
Kulesi sifundo, i-biopsy ehlosiwe isetshenziselwe ukulinganisa ukunemba lapho i-radiologist inikezela izinga le-PI-RADS izinga lesi-4 noma lesi-5, kungakhathaliseki ukuthi i-biopsy ibonise isamba se-Gleason se-7 noma ngaphezulu. Esikhathini sokutadisha, izithombe zalezi ziguli zaziwa futhi zalayishwa umuntu wesithathu oyimpumputhe. Ngakho-ke, ama-radiologists ahumusha yonke i-prostate MRIs ngokuzimela. I-"iphutha" efundwa ichazwe ngokuthi isabelo se-PI-RADS 4 noma 5 nge-biopsy yokulandelela eyabonisa uGleason 6, noma akukho mdlavuza noma yini. Enye "iphutha" efundwa kwakuyisabelo se-PI-RADS 1, 2 noma 3 lapho imiphumela ye-biopsy yayinguGleason 7 noma ngenhla.
Ukunemba kokufundwa kukadokotela kwasuka kumaphesenti angama-56 kuya ku-75 amaphesenti nokuthola okunembile akuzange kuhambisane nobude besipiliyoni somdokotela ukufunda i-MP-MRI. Ngakho-ke, lokhu kusho ukuthini isiguli? Kwakukhona ukuthi ukuhlanganiswa kwezincazelo ezivela kuzo zonke izaziso ze-radiologists ezine zanikeza imiphumela enembile kakhulu. Lokhu kusikisela ukuthi ukuhumusha ngokuvumelana kwe-prostate i-MRI kungaba indlela yokuthuthukisa ukunemba kokubikezela.
Iyiphi Impumelelo Amazinga E-Testosterone Akhona Ngama Scans?
Manje ukuthi i- MP-MRI iyanda ekuthandeni, omunye umbuzo obalulekile usuvele uthi, "Amazinga aphansi e-testosterone afaka kanjani ukuchithwa kwama-MP-MRI?" Lokhu kuyinkinga ebalulekile. Njengoba amadoda ekhula, amazinga abo ase- testosterone ahlala ehla. Njengoba ukwehlisa i-testosterone kuyaziwa ukuthi kunomphumela we-anticancer, amazinga aphansi e-testosterone angathinta kanjani i-MP-MRI?
Esinye isifundo, esivela ku-National Cancer Institute, sahlaziya iziguli ezingu-522 ze-hypogonadal. I-PSA yabo ephakathi yayingu-6.66 kanye ne-testosterone emaphakathi yayingama-171. La madoda angu-522 ayefaniswa namanye, iqembu elikhulu kakhulu lamadoda ama-testosterone aphakathi kwawo ayeyi-311. Kuvela ukuthi imiphumela yokucabanga emkhatsini wamacembu amabili ayefana, nakuba ayephansi kancane izinga lokutholakala komdlavuza ophawulekayo emitholampilo emadodeni we-hypogonadal (amaphesenti angu-28.8 no-37%). Kodwa-ke, amanani okuthola lapho i-biopsy ehlosiwe yenziwa ngayo (amaphesenti angu-40.4 vs. amaphesenti angu-43.6).
Kulaba bantu abangu-522, abangu-78 baqhubeka nokuphathwa ngokuhlinzwa. Imibiko yokugcina yokukhubazeka kulezi ziguli ezingu-78, (uma kuqhathaniswa namanye amaqembu abesilisa abahlinzekwa nge-testosterone evamile), yabonisa izinga eliphakeme lokuthuthukiswa kwamaphuzu eGleason (amaphesenti angu-22.2 vs. 12.5 amaphesenti), ukuhlasela kwe-vesical okuphindaphindiwe (11.1% vs 6.0) amaphesenti) kanye nokuhlasela okungaphezulu kwe-lymph node (amaphesenti angu-11.1 vs amaphesenti angu-7.5). Ngokusekelwe kulezi ziphumo zokutadisha, amazinga aphansi e-testosterone kufanele abangele odokotela babe yi-warier encane yezinto ezifunyenwe kahle ezibikwe nge-MP-MRI.
Esinye isifundo esivela eNyuvesi yaseCalifornia, eSan Francisco sahlola ukuthi i-PI-RADS ibikezela kanjani imiphumela yokuthola izifo emva kokuhlinzwa (cishe kumadoda ane testosterone evamile). Kulolu cwaningo lweziguli ezingu-121, abacwaningi babheka indlela iPI-RADS enhle eyabikezela ngayo ukuthi kwenzeke yini isiqephu esiphakeme seGleason (4 + 3 = 7 noma ngaphezulu) noma ukusakazeka komdlavuza ngaphandle kwe-capsule ye-prostate gland. I-MP-MRI ngaphambi kokuhlinza yabonisa ukuthi iziguli ezingu-69 eziyisi-73 ezinezifo eziphikisayo zinePI-RADS 4 noma 5. Nakuba abalobi bephetha ngokuthi amaphuzu e-PI-RADS angama-4 noma ama-5 azwela kakhulu ukutholakala nokubikezelwa kokubi i-pathology, i-PI-RADS engu-4 noma engu-5 ngaphezulu-ibikezela ukuthi i-pathology engalungile ngezinga elithile. Isibonelo, kuwo wonke amadoda ane-PI-RADS 4 noma 5 ngaphambi kokuhlinzwa, kuphela okubili kwezintathu zitholakale zine-pathology engalungile.
I-MP-MRI iphinde inikeze inzuzo ebalulekile ngaphezu kwe -biopsy engu-12 ephakathi kokungahleliwe emadodeni ekuqapha okusebenzayo-indlela ethanda ukuyikhetha yokuphatha umdlavuza wesibeletho seBanga 6. Ucwaningo lwanamuhla seluphelile ngokuthi iBanga 6 alikho amandla okusebenza ngokusemandleni. Ngamanye amazwi, ayikwazi ukusakazeka futhi akuwona umdlavuza ngempela. Ukuqapha okusebenzayo kwenza amadoda ahlehlise ngokuphepha ukuhlinzwa noma imisebe iminyaka eminingi.
Ukuhlola okusebenzayo kanye ne-Grade 6 Cancer Prostate
Uma kuyiqiniso ukuthi amadoda ekubukeni okubhekayo akufanele akhathazeke ngebanga leBanga lesi-6, ukukhathazeka kwangempela kungenzeka ukugcina ibanga lesi-7 noma ngaphezulu umdlavuza ongaphuthelwa yi-biopsy yokuqala engahleliwe. Ucwaningo lubonisa ukuthi i-biopsy engahleliwe ilahlekelwa izifo eziphezulu kakhulu amaphesenti angu-25 wesikhathi. Ukutadisha kusuka ku-UCSF, okukhulunywe ngenhla, kubikile ukuthi i-MP-MRI ithola iGleason 4 + 3 = 7 noma ngaphezulu amaphesenti angu-95 yesikhathi. Ngokusobala, lolu cwaningo lusekela ukuthi abantu abaneGleason 6 abacabanga ngokuqapha okusebenzayo kufanele babe ne-MP-MRI ukuqinisekisa ukuthi akukho CSC engaphuthelwa yi-biopsy engahleliwe.
Kwesinye isifundo, iqembu labodokotela elise-Ann Arbor, eMichigan futhi libheke inkinga yokwenza i-MP-MRI emadodeni aphishekela ukubhekwa okusebenzayo. Benza ukubuyekezwa okubukeziwe kwamadoda angu-225, angu-209 no-Gleason 3 + 3 = 6 no-16 no-Gleason 3 + 4 = 7. Konke kwaba ngaphansi kwe-MP-MRI elandelwa yi-biopsy ehlosiwe uma kune-lesion esolisayo. Imiphumela yabonisa ukuthi ngaphandle kokuthola i-MP-MRI, iziguli ezingu-12 ezinezifo eziphezulu eziphezulu zingahle zilahleke futhi zizofakwa ngendlela engalungile ekuhlolweni okusebenzayo. I-biopsy ekhonjisiwe ibonise ukuthuthukiswa kweGleason score kuya ku-Gleason 4 + 3 = 7 kuziguli ezimbili, kuya ku-Gleason 4 + 4 = 8 kuziguli ezingu-9 nakuGleason 4 + 5 = 9 kwesiguli esisodwa.
Izwi elivela
I-biopsy engama-12 eyingqayizivele, eyaqala ukuqala ngasekupheleni kwawo-1980, yayisikhathi esisodwa, indlela eyedwa yokuthola umdlavuza wesandulela ngculazi. Kodwa-ke, manje sesiyazi ukuthi ngonyaka ngamunye amadoda angaphezu kuka-100 000 anesifo esingenabungozi ebangeni lesi-6 atholakala nge-biopsy engahleliwe. Lokhu kutholakala kuholela ekwelapheni okungadingekile kumadoda angu-50 000 ngonyaka. Ngaphambi kokuba sifunde ukuthi singasusa kanjani amagama asetshenziswayo ebangeni le-6, ukuvikeleka okusemqoka ukugwema yonke into ehleliwe ye-needle 12-core. Amadoda anezinga eliphezulu le-PSA kufanele acabangele ukwenza ukuhlola kwegazi le-OPKO 4K. Uma imiphumela yokuhlola ibonisa ukuthi ingozi yesifo esiphakeme isifo esingaphezu kwamaphesenti angu-10, i-MP-MRI esikhungweni sobuhle kuyoba isinyathelo esilandelayo esilandelayo.
> Imithombo:
> Kim, E, Joel V, Anup S, et al. "I-MP08-11 ye-radiologicalist level level does not predict the accuracy of prostate mri incazelo yomdlavuza ophawulekayo emzimbeni: isivumelwane sifunda impendulo? I Journal of Urology 197, No. 4 (2017): e95.
> Mehralivand, S, Bednarova, S, Shih J, et al, "MP08-10 UKUHLOLA UKUHLOLA KWENKCAZELO YOKUSETSHENZISWA KWENKCAZELO YOKUPHILA KWENKQUBO YOKUPHILA KWENKULUNKULU NOKUHLELWA KWEZINDAWO VERSION 2." Journal of Urology 197, no. 4 (2017): e94-e95.
> Nguyen, H, Westphalen A, Niloufar A, et al. "I-PD65-11 INGABE I-PI-RADS V2 IMIGOMO YOKUPHILA KWESIKHATHI SESIKHATHI SOKUPHILA KWESIKHATHI SOKUPHAKATHI KWESIKHATHI SOKUPHILA?" The Journal of Urology 197, no. 4 (2017): e1270.
> Punnen, S, Freedland S, Polascik T, et al. "PD71-04 ISIHLOKO ESIKHULULEKILEYO, ISIKHATHI SE-MULTI-INSTITUTIONAL, ISIKHONO SOKUPHAKATHI EMINYANGWENI YEZEMVETERS UHLELO LWEZEMPILO LIQINISISA UKUPHAKATHI OKUQHELEKILE NGOKWENZEKA NGOKWENZA UKUQALA OKUQHELEKILE NGOKWENZEKA NGOKWENZA UKUQHUBA KWEZINDLELA ZEMPILO." Journal of Urology 197, no. 4 (2017): e1356-e1357.
> Russell CM, Amir H. Lebastchi ML, et al. "I-MP08-12 UKUHLOLWA KWEMIDI-INSTITUTIONAL YEMIYA NOKUSEBENZA IBIOPSY E-BIOPSY YOKUSEBENZA KWEZINDLELA ZOKUPHILA OKUSEBENZI." The Journal of Urology 197, no. 4 (2017): e95-e96.
> Sugano D, Sidana A, Calio B, et al. "MP14-07 UKUPHUMA KWEMHYPOGONADISM ESIQINISWENI SOKUQALA KANYE NOKUSEBENZA KUNCANSI." The Journal of Urology 197, no. 4 (2017): e164.