I-proton imisebe yindlela ephakanyisiwe yokushisa imisebe ethandwa ekuthandweni komdlavuza wesifo sofuba. Amadoda acabangela imisebe ye-proton adinga ukuqhathanisa futhi ahluke ngayo nayo yonke iminye imilayezo yokuthola imithi ukuze athole ukuthi ukwelashwa kweproton kuyasiza yini ngenxa yezimo zabo ezithile.
I-radiation egcwele yeproton idinga ukwelashwa okuyisihlanu ngeviki kuqhubeka amasonto ayisishiyagalolunye noma ayisishiyagalolunye alandelanayo.
Ngesikhathi sokuvakasha ngalunye, iziguli zimi phambi kwensimbi engabonakali yama-proton ehlose i-prostate gland.
Iproton ngokumelene ne-Photon Radiation
Imisebe ye-Proton ihlukile kwezinye izinhlobo zemisebe , encike kuma-photons. Imishanguzo ye-Photon ivela ngezinhlobo ezintathu: ukwelashwa kwemisebe eguquguqukayo (IMRT), imishanguzo ye-radiactive (brachytherapy), kanye ne-stereotactic radiation body radiation (SBRT). Ngezinye izikhathi inhlanganisela ye-brachytherapy ngokubambisana nenye yezinye izinhlobo zemisebe yensimbi isetshenziswa.
Zonke izinhlobo zemisebe zisebenza kahle, okuholela ekufeni kwamangqamuzana omdlavuza. Konke kungabangela imiphumela emibi, uma imishanguzo ithinta izitho ezijwayelekile ezijwayelekile, njenge-vessie, i-rectum, ne-urethra.
Ingozi Ye-Dysfunction Erectile
Kuze kube manje ochwepheshe abakwazi ukuvuma ukuthi uhlobo olulodwa lwama-radiation luyaqhubeka lukhuphuka wonke amanye. Kodwa-ke, kuye ngokuthi izinhlobo ezahlukene zezimo iziguli ezibhekana nazo, uhlobo olulodwa lwezokwelapha lungaba nezinzuzo ngaphezu kwabanye.
Zonke izinketho, uma zinikwe odokotela abanolwazi, zifinyelele amazinga omuthi wokwelashwa futhi zinemibala embalwa emibi engapheli-ngaphandle kweengozi ye- erectile dysfunction (ED).
Ingozi ye-ED engapheli-echazwe njenge-ED ayiphenduli ku-Viagra noma izidakamizwa ezifanayo-ingamaphesenti angaba ngu-50 nazo zonke izinhlobo zemisebe.
Ingozi iphezulu emadodeni amadala nasemadodeni anesifo sokuhlukunyezwa ngokocansi. Ingozi iphansi kubantu abasha futhi uma umsebenzi wokuzibandakanya ngokocansi ulungile. Ukwelashwa kwe-ED eyenziwe ngama-radi kuyasebenza kodwa kungavamile, futhi kudinga ukuthi umjovo we-prostaglandin ungene emthonjeni noma ukufakelwa kwesifiso sokufakelwa kwesisu.
Ngezansi, nakuba i-ED ngemuva kwemisebe ejwayelekile, ayithathwa njengesici esinqumayo ekukhethweni kolunye uhlobo lwemisebe ngaphezu kwesinye. Lokhu kungenxa yokuthi ingozi ye-ED iyafana nazo zonke izinhlobo zemisebe. Ngakho-ke, uma kuqhathaniswa nokukhethwa kwemisebe, kuncike kwezinye izici ezifana namanani okuphulukisa kanye nesifo senkinga yesibindi noma yama-rectal.
Ingozi ye-Burns Burns
Ngokomlando, ukusebenzisa ubuchwepheshe bokushisa ama-ray asebekhulile, ukushisa kwama-rectal kusuka emisebeni kwakujwayelekile futhi kungabhubhisa. Manje kule nkathi yanamuhla, ngenxa yezindlela ezingcono zokukhomba, ukushisa okukhulu kwama-rectal sekuvamile kakhulu. Njengamanje, zonke izinhlobo ezine zemisebe (i-proton imisebe, i-IMRT, i-brachytherapy ne-SBRT) inengozi efanayo (1 kuya kwezingu-2 wamaphesenti) wezinkinga ze-rectal yesikhathi eside.
Kukhona okungafani kokubili kulokhu okuqinisekisiwe. Okokuqala, ezinye izifundo ze-SBRT kodwa azikho konke okubonisa ukuthi zingase zibe nenengozi encane yokushisa kwama-rectal kunezinye izinketho ezintathu, ingozi emaphesenti amathathu kuya ku-4 ububanzi.
Okuhlukile kwesibili "imisebe ye-proton" endala. Imishini ye-proton endala inikeza isigxobo esikhulu somswakama, okungenzeka ukuthi kubangele imisebe "ye-overspray" engena e-rectum. I-proton imisebe yanamuhla, ebizwa ngokuthi i-proton therapy modulated therapy (IMPT) inikezwa ngokusebenzisa imishayo yamapenseli amancane, afana kakhulu nohlobo lobuchwepheshe obusetshenziselwa ukulethwa kwe-IMRT. Kokubili i-IMPT ne-IMRT ingadala insimu ye-radiation "ephihliwe" engahle ifakwe ukuze ihambisane eduze nakakhulu emingceleni ye-prostate gland. Lokhu kubangela ukushisa kwama-radiation angaphansi kakhulu futhi ngaleyo ndlela ingozi engezansi yokulimala komhlanga.
I-Gel Yokuvimbela Ukushisa Okubalulekile
Ukushisa komzimba okuvamile kungavamile, kodwa kungadala kakhulu, okubangelwa ubuhlungu, ukuphuma kwegazi nokulahleka kokulawulwa kwama-rectal. Ubuchwepheshe bokuguquguquka okuthiwa i-SpaceOAR kunciphisa kakhulu ingozi yokushisa okukhulu emgodleni. I-SpaceOAR hydrogel ijojowe phakathi kwe-prostate gland nodonga lwama-rectal futhi ihlala njalo phakathi nesikhathi semisebe. I-hydrogel ishukumisela udonga ohlangothini kude ne-prostate gland nasemkhatsini wensiza. Ngakho-ke, ingozi yokushisa imisebe emgodleni isiphelile.
Ingozi Yomlilo-Yenza Izinkinga Zase-Urinary
Izinkinga zase-Urinary emva kwemisebe zifaka ubuhlungu ngesikhathi sokuchama, ukuphuthuma komchamo, nokuvuka ebusuku ukuvuthwa. Ingozi yezibonakaliso ngemuva kokushisa imisebe yanda kumadoda anezinkinga zokungena emanzini nasemadodeni anezimbungulu ezinkulu ze-prostate.
Ingozi yezinkinga ze-urinary yanda futhi lapho kusetshenziselwa izimila zembewu. Lokhu kungenxa yokuthi inani eliphelele lemisindo ehanjiswa imbewu liphakeme. I-urethra, i- urinary passage ephethe umchamo kusuka kwesisu kuya ngaphandle nge-penis, igijima ngqo phakathi kwe-prostate. Ngakho-ke, ukucasuka okwesikhashana ngesikhathi sokushisa imisebe futhi ngokushesha emva kwemisebe kuvamile phakathi kwazo zonke izinketho.
Izimpawu zesikhathi eside zomgogodla zenzeka ngamaphesenti angu-10 noma kumadoda anemifino yokufaka imbewu. Izimpawu zesikhathi eside ze-urinary zingase zenzeke nezinye izinketho, kodwa ezingaphansi kwamaphesenti angu-5 weziguli, ecabanga ukuthi azikho izigulane ezinkulu noma izinga eliphawulekayo lezinkinga zokuvuthwa. Imishanguzo yokulwa nalezi zimpawu zesikhathi eside ze-urinary iphumelela kancane kancane. Kukhona ukuthambekela kwezimpawu zesikhathi eside ukuthuthukisa kancane kancane, nakuba ukuthuthukiswa okuphawulekayo kungenzeki iminyaka eminingana.
Ngokubanzi, ngaphandle kokungabikho okuncane okukhulunywe ngaye ngenhla, ingozi yemiphumela emibi ye-urinary ne-rectal ifana nezo zonke izinketho. Lokhu kusenza sikwazi ukubhekana namazinga okuphulukisa, okuhlukahluka kuye ngesifo somdlavuza wesiguli. Emadodeni abanjelwe ukushiswa kwemisebe, kunezigaba ezimbili ezibanzi zomdlavuza wesi-prostate kuye kwachazwa, "engozini enkulu futhi" engozini emaphakathi. "
Umshini we-High-Risk Prostate Cancer
Njengoba izifundo ezingcono zikhona zengozini enkulu, ukhetho lwezokwelapha luyinkinga encane kunezingozi eziphakathi. Amadoda anengozini enkulu abhekene okungenani okukodwa kokulandelayo:
• Ibanga le-Gleason lika-8 noma ngaphezulu
• I-PSA yezinga legazi ngaphezulu kuka-20
• Ukuhlolwa kwe-digital rectal okubonisa isifo esikhulu noma umdlavuza ngaphandle kwe-prostate
Ngezifo eziphakeme kakhulu, ochwepheshe batusa indlela "yokuphuma" indlela yokwelapha. Njengoba kuphawuliwe ngenhla, imisebe yembewu inikeza isilinganiso esiphezulu semisebe uma kuqhathaniswa nezinye izinketho. I-dose ephakeme ithuthukisa amazinga okuphulukisa. Ucwaningo olukhulu olubizwa ngokuthi i-ASCENDE-RT lwezilingo zokwelashwa luqinisekisa lokhu. Ucwaningo luqhathanise ngokuphumelelayo i-IMRT yodwa ne-IMRT kanye nokufaka imbewu. Ukuhlanganiswa kwembewu kanye ne-IMRT kubangele izinga lokuphulukisa eliphakeme elingamaphesenti angu-20 uma kuqhathaniswa nokwelashwa ne-IMRT yedwa. Ngakho-ke, kuvumelana ukuthi imishanguzo yembewu ehambisana ne-IMRT yindlela engcono kakhulu yemisebe yabesilisa abanesifo esiphezulu.
Njengoba kukhona ukufana okuningi phakathi kwe-proton therapy (i-IMPT) ne-IMRT, cishe kunengqondo ukufaka i-IMPT (plus imbewu) ye-IMRT kanye nembewu emadodeni anesifo esibucayi. Noma kunjalo, ukushintshana okunjalo akukaze kuqinisekiswe esilingo somtholampilo. Mhlawumbe lokhu kungaphumeleli kuncike kancane ezintweni ezithile zomzimba eziyaziwa ukuthi zihlotshaniswa nama-proton uma kuqhathaniswa nama-photons. I-anticancer energy ethunyelwe nge-proton beam isisindo se-prostate, iyanciphisa ukushiswa kwemisebe emasimini evamile eceleni kwegland.
Ngokuphambene nalokho, imisebe ye-photon idlula ngqo emzimbeni, eveza umzimba omkhulu emisebeni. Ukuphikisana okuyinhloko kokusebenzisa imisebe ye-proton esikhundleni se-IMRT kusekelwe kulokhu okushiwo yilokho okushiwo ukuthi kunciphisa inani lezinto ezijwayelekile zomzimba ezivezwe emisebeni.
Umshini weCarry-Risk Prostate Cancer
Kukhona ukuguquguquka okukhulu kakhulu kokuzikhethela ezinezifo ezibangelwa ubungozi obuphakathi. Imiphumela emihle ibhaliswe ngazo zonke izinketho. Kodwa-ke, ochwepheshe abaningi baqala ukuhlukanisa ingozi ephakathi yaba yi-subtypes ehle futhi engalungile. Ukusebenzisa lolu hlelo, amadoda ane-subtype evumayo kufanele ahlangabezane nalezi zindlela ezilandelayo:
• Gleason 3 + 4 (esikhundleni seGleason 4 + 3)
• Yizimbalwa ezimbili noma ezintathu kuphela zezinhlamvu ze-biopsy eziqukethe umdlavuza
• I-PSA yezinga legazi elingaphansi kweshumi
• Uma udokotela ezwa i-nodule, incane futhi iqukethe
Ngengozi ephakathi, zonke izinketho-imbewu, i-SBRT, i-IMRT, ne-proton (IMPT) imisebe-izoba nengqondo. Amadoda anezimbungulu ezinkulu ze-prostate, isibonelo esingaphezu kuka-60 cc kuya ku-80 cc, isibonelo, noma amadoda anezibalo eziningi kakhulu zokungena emanzini, abhekene nengozi ephezulu yezinkinga zokuvuthwa kwexesha elide ngemisebe yembewu futhi kufanele mhlawumbe akhethe i-SBRT, IMRT noma i-IMPT . Uma i-SpaceOAR i-hydrogel isetshenziselwa ukuvikela izingozi zomonakalo we-rectal, i-SBRT iyindlela ekhangayo ngaphezu kwe-IMRT nemisebe ye-proton, ngoba inani lokuvakashelwa okudingekayo ukwelashwa liphansi kakhulu ne-SBRT kuqhathaniswa ne-IMRT kanye nokwelashwa kweproton.
Umdlavuza wesifo sofuba ongathandeki phakathi komphakathi ugcina izici zobungozi obuphakathi (Gleason 7, PSA kusuka ku-10 kuya kwezingu-20 noma i-prostate nodule) ngokulinganayo kodwa ehluleka ukuhlangabezana nemigomo eqondile echazwe ngenhla ngenengozi ephakathi. Izibonelo yizi: Gleason 4 + 3, amadoda anesisindo esingaphezu kwesisodwa sengozi emaphakathi namadoda anezinhlamvu eziningi ze-biopsy ezinomdlavuza. Lezi zici zikhombisa uhlobo lwesifo esingase sibe nobudlova. Ngakho-ke, ukwelashwa kufanele kube inhlanganisela ye-IMRT (noma i-IMPT) kanye nokufakelwa kwembewu. Le ndlela ingase ibonakale ifana nalokho okwakunconywe ngenhla ngenxa yesifo esiphezulu. Kodwa-ke, kukhona umehluko omkhulu-indlela yokwelashwa kwe-hormone esetshenziswa ngayo.
Ukwelashwa kwamahomoni kuyadingeka ukuba wonke amadoda athole imisebe ngaphandle kwabesilisa abanengozi ephakathi. Ngokuvamile, i-Lupron noma imithi efana ne-Lupron iqalwa izinyanga ezimbili ngaphambi kokushiswa kwemisebe futhi yaqhubeka phakathi nemisebe. Amadoda aneengozi emaphakathi engalungile aqhubeka nokwelashwa kwe-hormonal izinyanga ezingu-6. Amadoda anengozini enkulu aqhubeka isikhathi eside, ema ngemva kwezinyanga ezingu-18. Ucwaningo olushukumisayo olwanyatheliswa eNew England Journal of Medicine lubonisa nokuthi uhlobo olunamandla lwe-hormone therapy olubizwa nge-Zytiga kufanele lunikezwe ngokuhlanganyela ne-Lupron yamadoda enengozi enkulu.
I-Proton Therapy Izinzuzo Nezinkinga
I-proton imisebe ingase ibonise ukuthuthukiswa okungeziwe ngaphezu kwe-IMRT ngenxa yokuncishiswa okuncishisiwe kwama-tissue womzimba okujwayelekile kuya emisebeni. Ngakho-ke, ezimweni ezichazwe ngenhla lapho i-IMRT ingacatshangwa khona, amadoda angakhetha ukukhetha imisebe yeproton ngaphezu kwe-IMRT. Izinzuzo ezikhonjisiwe zemisebe ye-proton ngaphezu kwe-IMRT zihlala zingenasisekelo futhi zingavinjelwe emitholampilo. Awekho ikhanda kuya ezihlokweni ezisenhloko uma kuqhathaniswa nemisebe ye-IMRT ne-proton.
Izinsalela ezihambisana nemisebe yeproton zihlobene nezindleko eziphezulu futhi iqiniso lokuthi akuzona zonke izinhlelo zomshuwalense ezihlanganisa imisebe yeproton. Ngaphezu kwalokho, kunezikhungo ezimbalwa ezenza imisebe ye-proton, ngakho ukukhathazeka kwezwe kungaba yisici esiyinhloko ngokubheka ukuthi ukuvakashelwa okuningi kuyadingeka esikhathini esingama-5 kuya ku-9.
Amadoda acabangela ukwelashwa komdlavuza wesi-prostate kudingeka enze umsebenzi wesikole. Imiphumela emibi evela emisebeni ingaba ingenakuguqulwa. Ukukhethwa kwemisebe enhle kufana nezimo zesiguli. Kunezici eziningi okumele zicatshangelwe uma kukhishwa imisebe.
> Imithombo:
> James, ND., Et al. "I-Abiraterone yomdlavuza we-prostate engaphathwa ngaphambilini nge-hormone therapy." I-New England Journal of Medicine (2017).
> Morris, JW, et al. "Ukuxoshwa kwe-Androgen kuhlanganiswe ne-Elective Nodal ne-Dose Escalated Therapy (The ASCENDE-RT Trial): Ukuhlaziywa kokuphela kokulinda ukuhlolwa okungahleliwe ngokuqhathanisa ukukhushulwa kwesibalo esincane esincane se-brachytherapy ekukhusheni okuphezulu kwe-dose umdlavuza we-prostate wobungozi obuphakathi. " I-International Journal of Radiation Oncology * Biology * Physics 98.2 (2017): 275-285.
> Zelefsky, MJ., Et al. "Ukusebenza kwe-sildenafil ngomlomo kuziguli ezine-erectile ukungasebenzi ngemuva kwe-radiotherapy ye-carcinoma ye-prostate." Urology 53.4 (1999): 775-778.