Iyiphi into eyesabeka kakhulu ngomdlavuza? Kwabaningi, ngumdlavuza wesikhala ungabuya ngemuva kokuhlinzwa. Ngama-cancers-colon ejwayelekile, isifuba, ubuchopho, i- melanoma , noma i-lung, isibonelo-lezi zikhathi eziphindaphindiwe cishe ziyingozi kakhulu emhlabeni wonke. Umdlavuza we-prostate, noma kunjalo, uhlukile. Ungase uthole kunzima ukukholelwa, kepha amadoda anezifo ezibuyiselweyo cishe angase afe kusukela ekugugeni kunomdlavuza wesibeletho.
I-Cancer ye-prostate ihlukile
Kungani umdlavuza we-prostate uphinde uhluke kangaka? Izizathu eziningana. Okokuqala, ikhula futhi isakazeka kancane kakhulu kunezinye izinhlobo zomdlavuza. Okwesibili, imishanguzo engacacisi i-testosterone (ukuvinjelwa kwe-hormone) iyasebenza ngokumangalisayo. Amadoda angena ekuxoxweni iminyaka eyi-10! Kodwa okwenza umdlavuza we-prostate uyingqayizivele kakhulu uhlobo oluthile lweprotheyini olukhiqizwa ku-prostate gland okuthiwa i-prostate-specific antigen, okunye okubizwa ngokuthi i-PSA.
I-PSA iyamangaza
Ngisho noma ukulinganisa inani le-PSA egazini lomuntu ukuze kukhishwe umdlavuza kuye kwabuzwa ngokungathí sina, i-PSA yindinganiso yegolide yokuthola izifo ezivuliwe. Eqinisweni, ezinye izinhlobo zomdlavuza azikho lutho oluze zifinyelele ngokunemba kwe-PSA. I-PSA ithola umdlavuza omncane. Ngeshwa, ezinye izifo zomdlavuza zingatholakala kuphela ngesilinganiso, ngemuva kokuba izicubu eziphindaphindiwe zibe zikhulu ngokwanele ukuze zibonwe ngamehlo.
Ukuze izicubu ziboniswe ngokuskena, kumele zibe ngaphezu kwamasentimitha ububanzi ububanzi futhi ziqukethe amangqamuzana omdlavuza wesigidi esisodwa . Ukuhlolwa kwegazi kwe-PSA, ngakolunye uhlangothi, kuthola ukuphindaphinda kabusha njengambalwa amaseli angu-100,000.
I-PSA Isikhathi sokungabaza sinembile kakhulu kune-Gleason Score
Ukubona ukuphindaphindiwe ne-PSA ngesikhathi sokuqala esingaba khona kudala ithuba lokuthola ubunzima bokubuyela emuva.
Ngokuhlolwa okuphindaphindiwe, okulandelanayo kwe-PSA-kusho ngegazi lezinyanga zonke-izinga lokunyuka kwe-PSA linganqunywa ngokunembile. Yeka ukuthi ngokushesha ama-PSA kabili abonisa kanjani izinga lokubuyela emuva. Lolu lwazi lubaluleke kakhulu ngoba ukuphindaphinda kwebanga eliphansi liphathwa ngokuhluke kakhulu kunezikhathi eziphezulu zokubuyela emuva.
Iningi labantu lijwayele uhlelo lokubamba i-Gleason, indlela evelele kakhulu yomdlavuza obala emadodeni asanda kutholakala , okungukuthi, ngaphambi kokubuyela emuva. Ngesimiso se-Gleason, amangqamuzana omdlavuza athathwa udokotela okhethekile obizwa ngokuthi i-pathologist. I-pathologist ibheka isampula ye - biopsy ngaphansi kwe-microscope bese ibeka ibanga kumdlavuza . Uhlelo lwe-Gleason luyisibonakaliso esinamandla kunazo zonke sokufaka umdlavuza wesifo sofuba osanda kutholakala futhi sinendima ebalulekile ekunqumeni ukwelashwa okulungile kwamadoda asanda kutholakala. Kodwa-ke, emdlalweni we-prostate ophindaphindiwe, isikhathi se-PSA sokuphindaphindiwe kalula sithatha kalula ukunemba kwe-Gleason score. Ulwazi lwezinga lokukhula komdlavuza yindlela enembile kunazo zonke yokulinganisa ukuhlukunyezwa komdlavuza, futhi ngenhlanhla, i-PSA inquma lokhu ngokulinganisela okungalingani.
Uma isikhathi se-PSA sokuphindaphindiwe sibonisa ubukhulu bokuphindaphinda, isulelo sokwelapha sisetshenziswa.
Ukwelashwa kuyahluka kakhulu kuye ngokuthi izinga lokuphindaphinda, ngakho-ke uhlobo oluhle lwezokwelapha ebangeni ngalinye lokuphindaphindiwe lixoxwe ngezansi.
Ukuphindaphinda okuphansi kweBanga
Ngezinhloso ezichazayo, amamaki amathathu aphinde abuyele angachazwa: aphansi, aphakathi, aphezulu. Ukwazi izinga lokuphindaphinda yisisekelo sokhetho lwezokwelapha. Ezinye zibuyela emuva, isibonelo, zinezinga eliphansi kakhulu kangangokuthi ngeke kudingeke ukwelashwa. Lokhu kwenzeka uma i-PSA idinga okungaphezulu konyaka ukuphinda kabili. Uma isikhathi sokuphindaphindiwe sihamba kancane, indlela engcono kakhulu ukugwema ukwelashwa nokuqhubeka nokuqapha i-PSA njalo ezinyangeni ezintathu kuya kweziyisithupha.
Eziningi zalezi ziguli zihlala zilashwa ngokuphakade.
I-Intermediate-Grade Ukubuyela emuva
Uma amadoda anezikhathi ze-PSA eziphindwe kabili ezingamanye ama-brisker, zithi ezinyangeni eziyisithupha kuya kwezingu-12, ngokuvamile zizobe zikhethwe ngenye indlela yokwelapha. Ngokomlando, ukwelashwa kuye kwaba nokudubula kwamatshe emfucumfucu endaweni yomzimba lapho i-prostate itholakale ngaphambi kokususwa kwayo. Indawo ehlosiwe ibizwa ngokuthi i-prostate fossa. Ngezinye izikhathi imishanguzo esetshenziswe kule ndlela izoba nokwelapheka. Ucwaningo lubonisa ukuthi amazinga okuphulukisa ahamba phambili uma ama-radiation eqala ngaphambi kokuba i-PSA ikhuphuke ngenhla 0.5. Njengezinhlobo eziningi zokwelapha umdlavuza, ukwelashwa kwasekuqaleni kuqaliswa ngcono.
Ukwelashwa kwamaHormonal
Uma imishanguzo engaphumeleli, ukwelashwa kwama-hormonal kuyindlela elandelayo yokuzivikela. Indlela evame kakhulu ukukhetha i-agent evela ohlwini olude lwe-agent yama-hormone esebenzayo yokusebenza okulinganayo okulingana-Lupron, Trelstar, Eligard, Firmagon, noma i-Zoladex. Le mithi ejojelwayo isetshenziswa ngokuyisisekelo njengendlela yokusekelayo uma imisebe ihluleka ukulawula iPSA ekhulayo. Amaseli omdlavuza we-prostate adinga ukuthi i-testosterone iphile, futhi le mithi isebenza ngokunciphisa i-testosterone. Ukulahla amangqamuzana omdlavuza we-testosterone kubangela ukuba bafe. Ukuvimbela ama-hormonal kudala umphumela wokugcina i-antiticancer okugcinwe iminyaka engama-10, ucabanga ukuthi ukwelashwa kuqale ekuqaleni, okungukuthi, ngaphambi kokuqala kwamathambo ayisisindo. Isikhathi sokulawulwa kwezifo sifushane kakhulu uma umdlavuza wesi-prostate uvunyelwe ukuba uqhubekele emathanjeni ngaphambi kokuqala ukwelashwa.
Ukwelashwa okungajwayelekile
Ukuze unciphise imiphumela emibi yokuba nomthelela we-testosterone ophansi, amaholide okuphatha ngezikhathi ezithile avame ukuphakanyiswa. Indlela evamile ukuphatha uLupron izinyanga eziyisithupha kuya kweziyisishiyagalombili bese uthatha iholidi. Ngokuvamile i-PSA yehla ingaphansi kuka-0.1 ezinyangeni eziyisithupha zokuqala ukwelashwa. Ngemuva kokuba imithi ivaliwe futhi imiphumela yayo igugile, i-testosterone ibuye ithole futhi i-PSA iqala ukuphakama. Umjikelezo wesibili we-Lupron uqala uma i-PSA iphakamisa emkhawulweni ongenakuqhathaniswa, yisho phakathi kwezintathu nesithupha. Ucwaningo lubonisa ukuthi le ndlela ephakathi ilawula kahle umdlavuza kanye nokuthi i-Lupron inikezwa njalo.
Uhlobo lwe-Milder Uhlobo lwe-Hormone Therapy
Ngezinye izikhathi amafomu omlomo, okwenziwa ngomlomo we-hormone therapy njengeCasodex (bicalutamide), noma ngaphandle kwe-Avodart (i-dutteride), ingafakwa endaweni yeLupron ukunciphisa imiphumela emibi. Lolu hlobo lendlela lungase lukhethwe, isibonelo, kuziguli ezisebekhulile noma ze-frailer. Imiphumela emibi ejwayelekile ehambisana nezinhlobo ezijwayelekile ezingenakulungiswa zokwelashwa kwe-hormonal-ukukhathala, ubuthakathaka, nokuzuza kwesisindo-zivame ukuba nzima kakhulu. Kodwa-ke, kunomphumela owodwa ohlangothini ovame kakhulu ukukhula kwebele le-Casodex. Le nkinga, kodwa, ingaqhathaniswa nephilisi evimbela i-estrogen okuthiwa i-Femara. Ngaphandle kwalokho, umthamo olinganiselwe wemisebe ehlinzekwa endaweni yesifuba ngaphambi kokuba i-Casodex iqalwe kuvame ukuvimbela ukukhuliswa kwesifuba.
Ukwelapha Ukubuyela Ezingeni eliphezulu
Amadoda aphethwe umdlavuza we-prostate aphinde aphinde abuyele isikhathi sakhe se-PSA esingaphansi kwezinyanga eziyisithupha sibhekane nesimo esibucayi kakhulu. Uma lesi sifo singagcinwa isheke ngemithi ephumelelayo, umdlavuza kungenzeka usakaze ngokushesha futhi ube usongela ukuphila. Lapha, indlela yokwelashwa ehlakaniphile kunazo zonke ukuthola uhlelo oluhlukumezayo oluxhomeke ekuhlanganyeleni kwezokwelapha ezinikezwe ngesikhathi esifanayo, i-aka indlela yokwenza izindlela eziningi. Okusele kwalesi sihloko kuzokhipha ukwelashwa kokubuyela emuva kwezinga eliphezulu.
I-State-of-the-Scans Scans
Isinyathelo sokuqala ukusebenzisa ubuchwepheshe bokuskena okucacile ukuthola ukuthi emzimbeni umdlavuza ukhona. Njengamanje, i-lymph node engcono kakhulu etholakalayo (i-lymph nodes ngokuvamile iyisayithi yokuqala ye-metastases) yi-C 11 Acetate noma C 11 Choline PET. Ngeshwa, e-United States lezi zindlela zitholakala kuphela e-Phoenix Molecular noma eMayo Clinic. Muva nje, uhlobo olusha lwe-PET scan okuthiwa u- Axumin selutholakale kakhulu. Izifundo eziqhathanisa ukuchithwa okuhambisanayo kwe-Axumin ne-C 11 PET ziyasebenza. Enye, uhlobo olusha lwe-PET scan okuthiwa i-Gallium 68 PSMA manje ingena ezivivinyweni zomtholampilo ezindaweni ezihlukahlukene ezizungeze i-US.
Ngaphandle kwe-lymph nodes, ukuqhubekela phambili komdlavuza wesifo sofuba ngokuvamile kufaka emathanjeni. Ukubaluleka kwezinkomba ezinembile ukuthola izifo zakuqala akunakugxila kakhulu. Muva nje, ubuchwepheshe bokuskena amathambo buye kwathuthukiswa kakhulu ngokusetshenziswa kobuchwepheshe obusha be-F 18 PET. Noma kunini lapho kunokwenzeka khona, ama-F 18 PET ama-bone scans kufanele asetshenziswe esikhundleni se-Technisium 99 yenqubo endala. Ukuhlolwa kwe-PET ngomdlavuza wesifo sofuba kuyi-intuthuko entsha yentuthuko, okuvumela odokotela ukuba basebenzise imisebe enokuphefumula ngendlela ehlakaniphile kakhulu.
I-Radiation Plus I-Lupron Plus Casodex
Uma izinga lesifo selinqunywe ukuskena okunembile, kucabanga ukuthi inani le-metastase lilinganiselwe, (ungasho okungaphezu kwamahlanu), isinyathelo sokuqala sokuqala ukwelashwa nge-Lupron plus Casodex ngenhloso yokuqhubeka nayo okungenani ngonyaka. Ngokuvamile, izinyanga ezimbalwa ngemva kokuqala i-Lupron, imisebe yenziwa emasimini awaziwayo (lawo atholakala ngokuskena) kanye nokuphathwa kokwelashwa kwemisebe ye-prostate fossa nakwe-"normal" lymph nodes. Lezi zindawo zomzimba ziphathwa ngenxa yokuthi yindawo ejwayelekile kakhulu yezifo ezincane, futhi ngisho nezilinganiso ze-PET zanamuhla zingase zihluleke ukuthola umdlavuza lapha.
Izifo Ezincane Ezincane Ngaphandle Kwendawo Yomsakazo
Ucwaningo lubonisa ngokucacile ukuthi lapho imisebe iqondiswa kumasayithi awaziwayo wesifo, inzalo yomdlavuza kulawo masayithi ivame ukutholakala. Ngakho-ke, ukwehluleka kokwelapha kuvame ukuhlobana nezifo ezincane zezifo ezincane kwezinye izingxenye zomzimba ezingazange zitholakale, naphezu kobuchwepheshe bokuskena obukhona kakhulu. Ngakho-ke, lapho sibhekene nalezi zinhlobo eziyingozi kakhulu zomdlavuza wesifo sofuba obunezikhathi eziphindaphindiwe ngokuphindaphindiwe, ukusebenzisa isu elivuthayo elisebenzisa imithi yokwelapha enomzimba wonke womzimba kwenza wonke umqondo. Njengoba sekushiwo ngenhla, ukwelashwa kwe-anticancer kuphumelela kakhulu lapho uqala ukwelashwa ekuqaleni, ngenkathi lesi sifo sisencane kakhulu.
Imithi Ehlukahlukene Yokuqeda Izifo Ezincane
Njengoba i-Lupron ne-Casodex ingaba abadlali abanjengobalulekile emdlalweni wezokwelapha, abanye bangase bazibuze ukuthi kukhona yini ezinye izinhlobo zokwelapha ezisebenza kahle. Uma umbuzo uhlelwe ngale ndlela, imithi emibili ifika engqondweni ngokushesha, i-Zytiga ne-Xtandi. Lezi zithunywa ezinamandla ziye zabonisa ukusebenza kwe-antiticancer ngisho nalapho kuphathwa amadoda aphethwe umdlavuza eLupron! Njengoba kucabangela ukuthi kukhona ama-opharetha avumelekile ngomlomo ophethe iphrofayili yethonya eliphathekayo, kunengqondo ukucabangela ukufaka iZytiga noma i-Xtandi ye-Casodex.
Kuthiwani Nge-Chemotherapy?
Ngaphezu kokusebenzisa inhlanganisela yemithi, njengoba kwakunjalo nendlela echazwe esigabeni esandulele, imibiko iphinde ikhombise ukuthi ukwengezwa kwe- chemotherapy nemithi ebizwa ngokuthi i-Taxotere inamandla okuqhubeka nokuthuthukisa ukusinda. Nakuba iziphetho ezinjalo ziyimpumelelo, ukuhlola ukuhlola inhlanganisela ye-Taxotere ne-Xtandi noma i- Zytiga kubonisa ukuthi le ndlela ingahle ifinyeleleke.
Isiphetho
Amadoda aphethwe ngumdlavuza wesibeletho ngemva kokuhlinzwa angakwazi ukulinganisa ubukhulu obulodwa-yonke indlela yokwelapha. Uma isikhathi se-PSA sokuphindaphindiwe sihamba kancane, amadoda angabonwa ngokuphepha. Uma isikhathi se-PSA sokuphindaphindiwe sisanda ngokushesha, imishanguzo, i-Lupron, noma kokubili ingakwazi ukufeza ngokuqhubekayo ukuguquka kwezifo iminyaka engaphezu kweyishumi. Amadoda aphinde abuyele ngokugadluzwa ngesigwebo esisheshayo kakhulu se-PSA kufanele abheke ngokuqinile ukuqaliswa okusheshayo kwezinqubo eziningi zokwelashwa ngokubambisana.
> Imithombo:
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> Nabid A et al. Isikhathi sokwelashwa kwe-androgen yokuncishiswa komdlavuza emdlalweni omkhulu wesifo sofuba: isilingo esingahleliwe. I-Journal ye-Clinical Oncology. 31.18 ukudlala: LBA4510, 2013.
> Sandblom G et al. I-Positron emission tomography ne-C11-acetate yokuthola i-tumor kanye nokwehlukaniswa kwamakhemikhali ngeziguli ezine-prostate-specific specific relapse emva kwe-prostatectomy eqinile. Urology . 67.5: 996, 2006.
> Scholz M et al. Ukuhlolwa okubukeziwe kwe-gm-csf, i-dose ephansi ye-cyclophosphamide, ne-celecoxib ngesikhathi se-psa sokuphindaphindiwe (dt) emadodeni anomdlavuza we-prostate kanye ne-psa ephindaphindiwe ngemva kokuhlinzwa noma imisebe. I-Journal ye-Clinical Oncology . 28.10 isilwane: abstr e15061, 2010.