Ukuhlolwa okuphelele kwesifo somdlavuza we-prostate kufanele kutholakale umdlavuza we-prostate ophakeme kakhulu ngenkathi ugwema ukuxilongwa ngokweqile kwamagciwane angenangqondo, aphansi (i-Gleason 6 ehlukahlukene). Emuva ngo-2011, i-US Preventative Task Force Force (USPSTF) inconywa ngokumelene nokuhlolwa okuqhubekayo kwe-PSA kumadoda aphilile ngenxa yokwelashwa okudlulele kwegciwane eliphansi.
Inkinga yayingekho esandleni, isixazululo kuphela esingaba nayo kwakuwukudambisa ukuhlolwa kwe-PSA. Kodwa-ke, phakathi neminyaka emihlanu edlule kusukela kulezi zincomo zokuqala zenziwe, sekuye kwacaca ukuthi imbangela yangempela yokuxilongwa ngokweqile i- 12-core needle biopsy , hhayi iPSA.
Ngeshwa, i-biopsy eyi-12-core okungahleliwe iyaqhubeka iyindlela ejwayelekile kumadoda anePSA ephakanyisiwe. Noma kunjalo, ubuchwepheshe obusanda kuthuthukiswa inikeza enye indlela yokwenza i-biopsy engahleliwe. Kuvela ukuthi ukucabanga nge-MRI multi-parametric (mp-MRI) kuyindawo engcono kakhulu ye-biopsy engahleliwe. Into enhle mayelana ne-mp-MRI ukuthi ihlonipha ngokunembile umdlavuza we-prostate ophakeme kakhulu ngaphandle kokuthi uhlolisise uhlobo olungenabungozi lomdlavuza we-prostate (iBanga 6). Izifundo eziningana ezihlobene nalesi sihloko zanikezwa emhlanganweni we-American Urology Association (AUA) we-2016 eSan Diego. Lesi sihloko sihlola lezi zifundo ezibalulekile, siphakamisa ukuthi ukucubungula i-prostate ezindaweni eziphezulu zokusebenzisa i-MRI eminingi ye-3T iveza kahle umdlavuza wezinga eliphezulu futhi inenzuzo ngaphezu kwe-biopsy engahleliwe.
I-Studies Behind Prostate Cancer Diagnosis Test
Njengoba inkinga enkulu ngokuhlolwa kwe-PSA ukuthi cishe njalo iholela ngqo kwi-biopsy ye-12-core okungahleliwe, isifundo sokuqala engingathanda ukusikhombisa sihlobene nezingozi ezingase zibe khona ze-biopsy engahleliwe.
I-Abstract MP53-13 eyabhalwa nguDkt. Alaina Garbens, yabheka ukuthi bangaki abantu abafakwe esibhedlela ngemuva kokuhlaselwa kwe-biopsy okungahleliwe.
Wabheka izinga lokungeniswa esibhedlela lamadoda angu-61 910 ababhekana ne-biopsy engahleliwe e-Ontario, eCanada phakathi kukaJanuwari 2006 noDisemba 2013. Lolu cwaningo lwahlola amanani okufa kanye namazinga okungeniswa esibhedlela ezinsukwini ezingu-30 zokuqala ngemuva kokuba i-prostate biopsy yenziwe.
Bathola ukuthi ithuba lokufa kusuka ku-biopsy lalilodwa ezinkulungwaneni eziyishumi. Izinga lokungena esibhedlela ezinsukwini ezingu-30 zokuqala emva kwe-biopsy kwakungamaphesenti angu-3.5. Kulokho amaphesenti angu-3.5, ama-third-fourths ala madoda avunyelwe ukwelashwa kwesifo. Njengombhalo ohlangothini lwalolu cwaningo, uDkt. Garbens uphinde wachaza ukuthi inani lezinhlayiyana ezenziwayo liye lahlehla ngamaphesenti angu-30.6 uma kuqhathaniswa nenani lezinhlayiya ezenziwe ngaphambi kwezincomo ze-USPSTF.
Ucwaningo olwengeziwe olwenziwe ku-AUA lubheke phambili ukuthi izincomo ze-USPSTF zithinta kanjani umdlavuza otholakala. Zombili lezi zifundo zikhombisa ukwanda okukhulu kakhulu ebangeni lomdlavuza okutholwa ngoba i-USPSTF yenza incomo yayo yokuyeka ukuhlolwa.
Abstract MP39-04 nguDkt. Carl Olsson wabika ukuthi izincomo ze-USPSTF ngo-2011 zanyatheliswa zincoma ukuthi odokotela bafuna ukuhlolwa kwe-PSA-amadoda amaningi atholakala anezikhwama eziphezulu eziphezulu:
Unyaka | Amadoda Gleason 8 kuya ku-10 |
2010 2011 | 14.8% 14.8% |
2013 | 19.7% |
2014 | 25.4% |
Ngokusobala, iphesenti lamadoda athola ukuthi unomdlavuza we - prostate eliphezulu kakhulu.
Abstract PD09-03 eyabhalwa uDkt Glen Gejerman futhi kuqhathaniswa ukusatshalaliswa kwebanga lamacala amasha ahlolwe ngaphambi nangemva kwezincomo ze-USPSTF. Wahlola amadoda angama-2513 ahlanganiswa ngonyaka ka-2011 no-1665 abanjwe ngo-2014. Isilinganiso se-Gleason esiphezulu sashintsha kusukela ngo-6 ngo-2011 kuya ku-7 ngonyaka ka-2014. Izibalo eziphezulu ze-Gleason (8-10) zitholwe ngamaphesenti angu-19 we-biopsies ka-2014 kuphela Amaphesenti ayisishiyagalolunye ama-biopsies akwenziwa emuva ngo-2011.
Ucwaningo olwandulelayo lubonisa ukuthi izincomo ze-USPSTF zokushiya ukuhlolwa kwe-PSA kunciphisa inani lamadoda ahlolwayo e-PSA.
Umphumela wenetha ukunciphisa ukuxilongwa kweGleason 6-uhlobo oluphansi lwesigaba somdlavuza wesicathulo samadoda asebenza nge-biopsy. Lokhu kwakuwumphumela ohlosiwe wezincomo ze-USPSTF. Lapho i-USPSTF yenza izincomo zabo emuva ngo-2011, bekungekho okunye okunye okungafani nokwenza i-biopsy ye-12-core okungahleliwe yokuhlola amadoda anezinga eliphezulu le-PSA. Ngakho-ke ukuze sinciphise inkinga enkulu yokuhlola kabanzi izifo eziphansi, i-USPSTF yenza isinqumo sokudikibala ukuhlolwa kwe-PSA ngokuphelele.
Okushiwo lokhu: Le ncomo kungenzeka ukuthi ibuyele emuva ngo-2011. Kodwa-ke, manje kukhona ubuchwepheshe obusha obuhlinzekela okunye okusemandleni okwenza i-biopsy engahleliwe.
Izifundo eziyisithupha ezilandelayo ezivela emhlanganweni we-urology wezi-2016 zibonisa ukuthi i-MRI ehlukahlukene elandelwa yi-biopsy ehlosiwe ithola ngokunembile umdlavuza we-prostate ophezulu futhi ivalwe kakhulu inkinga yokuhlola okungaphezulu kwesigaba 6.
Abstract MP16-17 obhalwe nguDkt. Yasukaza Nakanishi wahlola ukunemba kokwenza i-biopsy ehlosiwe yezilonda ezisolisayo ezitholakale nge-MRI eminingi-parametric (i-mp-MRI) ye-prostate. Waqhathanisa imiphumela yokwenza i-biopsy ehlosiwe nemiphumela etholakalayo ngokwenza i-biopsy engu-14 enomlando okungahleliwe. Esifundweni sakhe, wahlola amadoda angu-202 anezinga eliphezulu le-PSA nge-MRI multi-parametric (mp-MRI). Zonke izilonda ezisolisayo ezitholakale ngu-mp-MRI (PI-RADS-3 ngenhla) zihlosiwe. Umdlavuza ophezulu "uchazwe ngokuthi iGleason score ≥4 + 3 noma ubude bomdlavuza ubude ≥5 mm. Bathola ukuthi i-biopsy ehlosiwe yathola amaphesenti angu-88 amadoda ayenomdlavuza ophawulekayo namaphesenti angu-97 amadoda ayenesifo esasiyi-Gleason 8 noma ngaphezulu.
Abstract PD15-08 obhalwe ngu Odokotela. UPeter Choyke noPeter Pinto bahlola izimbangela eziphezulu zezifo eziphezulu ezilahlekelwa yi-biopsy ehlosiwe kumadoda ayi-1003. Bika ukuthi i-biopsy ehlosiwe ilahlekelwe yi-Gleason 7 izifo ezingamaphesenti angu-11 futhi ilahlekelwe iGleason 8 noma ngaphezulu ngamaphesenti amabili. Ukubukezwa kabusha kwezithombe ze-mp-MRI zalesi siguli kubonise ukuthi izingxenye ezimbili kwezintathu zazo zinezilonda ezibonakalayo ezilahlekelwa udokotela ukuhumusha ukuskena. Cishe konke okusele, udokotela owenza i-biopsy yenaliti usuke elahlekelwe isilonda. Amaphesenti angu-1 kuphela ala madoda aye nomdlavuza we-MRI-ongabonakali. Ngamanye amazwi, ezimweni eziningi ukwehluleka kwe-biopsy okuhlosiwe ukuthola umdlavuza kwakungenxa yokufunda ngokucophelela kwe-MRI noma ukuhloswe okuhloswe ngudokotela okwenza i-biopsy yenaliti. Ngokusobala, isithombe sokucabangela sisebenza kahle, kodwa isiguli kudingeka siqaphele ukuthi ngeke sithembeke ngaphandle kokuthi sisebenzise ngobuchwepheshe odokotela abaqeqeshwe nabaqeqeshiwe.
I-abstract PD15-11 eyabhalwa nguDkt. Amanda Lu ihlose ukungabi nhlobo kokubikezela kwe-mp-MRI uma kuqhathaniswa ne-biopsy engahleliwe. "Inani elibi lokubikezela" lisho ukuthi kungenzeka ukuthi umdlavuza awukho uma ukhona. Amadoda ane-PSA ephakanyisiwe i-mp-MRI ayibonanga izilonda ezinonya zathola i-biopsy engama-12 okungahleliwe. Ngaphandle kwamadoda angu-53 ane-mp-MRI engabonisi izilonda, amaphesenti angu-3.8 kuphela atholakale ephethe umdlavuza owawuwumdlavuza ophawulekayo emzimbeni (Gleason≥7) njengoba kunqunywe yi-biopsy engu-12.
I-abstract MP21-15 eyabhalwa nguDkt. Jan Philipp Radtke iqhathanisa ukunemba kokuthola kwe-mp-MRI nokuhlinzwa. Wahlola amadoda angama-120 athola i-mp-MRI eqondiswe ukuxuba i-fusion biopsy ngaphambi kokuhlinzwa. I-mp-MRI ithole i-110 (amaphesenti angu-92) wezilonda eziphawulekayo uma kuqhathaniswa nokuthola izifo ngemuva kokuhlinzwa. Kulawa, i-fusion biopsy ihlolwe ngamaphesenti angu-80 alawa makhulu aphezulu. Futhi, lokhu kubonisa isidingo sokuba nodokotela abanekhono nabanolwazi ukuze benze i-biopsy ehlosiwe.
Abstract MP53-02 eyabhalwa nguDkt. Joseph Mahon ubuyekeze amarekhodi angama-395 amadoda anePSA ephakeme ngokutholakala komdlavuza wesifo sofuba. Wonke la madoda ayeke a-mp-MRI ngaphambi kwe-biopsy engahleliwe. Amadoda angenayo izilonda eziphawulekayo ezitholakalayo kwi-mp-MRI noma ngezilonda ezincane ezicatshangelwa ukuthi awunomdlavuza (PI-RADS 1-2) zihlolwe. Amadoda angamakhulu ayisithupha namashumi ayisishiyagalolunye nesishiyagalolunye agcwalise lezi zindlela futhi afakwe kulolu cwaningo. Bonke babhekana no-12-core biopsy. Ngokuvamile, umdlavuza wesifo sofuba wabonakala ngamadoda angu-54 (amaphesenti angu-32) angu-47 (amaphesenti angu-88) ayeyiGleason 6 noma i-uni-focus Gleason 3 + 4. Isifo esibalulekile, okungukuthi, uGleason 4 + 3 watholakala ngamaphesenti angu-10 amadoda kanye neGleason 4 + 4 kwaphawulwa ngamaphesenti amabili. Ngamanye amazwi, inani elibi lokubikezela le-mp-MRI evamile kulolu cwaningo lwangamaphesenti angu-88.
Abstract MP53-15 obhalwe ngu Odokotela. UPeter Choyke noPettu Pinto bahlolisise ukunemba kwe-mp-MRI fusion biopsy ekubukezweni kwezikhungo eziningi. Amadoda asesifundo athola i-mp-MRI yokuqala elandelwa yi-fusion biopsy eyayilandelwa yi-biopsy engama-12 okungahleliwe. Uhlobo lomdlavuza we-prostate olutholakala lwahlukaniswa ngezigaba ezintathu: Izingozi ezincane (Gleason 6 noma ivolumu elincane Gleason 3 + 4 = 7), Intermediate-Risk (ivolumu ephezulu Gleason 3 + 4 = 7), ne- High Risk (Gleason of 4 + 3 noma ngaphezulu).
Ingqikithi yamadoda angama-395 e-biopsy-naive atholakala ezikhungweni ezine ezibandakanyekayo. I-Fusion biopsy ithola ukuthi isifo esiphezulu se- High-Risk kune-12-core biopsy (22,3% ngamaphesenti angu-20.3). Ukwengeza, i-fusion biopsy ithole amaphesenti angu-18 ambalwa ambalwa ka-Gleason 6 (amaphesenti angu-15.7 no-19.2 amaphesenti). Ama-fusion biopsy alahleke kuphela amadoda amane anesisindo esiphezulu futhi one- High-Risk etholakala yi-biopsy engahleliwe.
Okushiwo lokhu: Izifundo eziyisithupha ezandulele zibonisa ukuthi i-mp-MRI iqondise ukuxilongwa kwe-fusion biopsy izifo eziphakeme kakhulu okungenani kanye ne-biopsy engahleliwe, uma kungcono. Kodwa inzuzo yangempela ye-mp-MRI ngaphezu kwe-biopsy engahleliwe yizinga eliphansi lokuthola umdlavuza ophansi. Enye ubuhle be-mp-MRI abanye abantu bangakwazi ukuyeka i-biopsy ngokuphelele. Emadodeni adinga i-biopsy, kuyadingeka kakhulu ama-biopsy cores.
Isifundo sokugcina esivela emhlanganweni we-AUA ohambisana nalesi sihloko sibheka umbuzo wezindleko.
Abstract MP53-14 obhalwe nguDkt. UPeter Choyke noPeter Pinto bevela eNational Cancer Institute eBethesda, bahlola izindleko ze-prostate i-MRI uma kuqhathaniswa ne-biopsy engahleliwe. Izindleko zamadoda angu-100 abhekana ne-biopsy engahleliwe ($ 1,410 kumuntu ngamunye) ngu-$ 141,035. I-biopsy engahleliwe ingabe ingamanga ngamadoda angu-13 futhi amadoda angama-24 angamanga.
Izindleko ze-mp-MRI ye $ 633 ne-MRI fusion biopsy ye $ 2,138. Izindleko eziphelele zokuthola i-MRI yokuqala ye-prostate kumadoda angu-100 aneziguli kuphela ezine-target lesion (s) ezibhekene ne-biopsy ehlosiwe, inqume ukuba ibe ngu-$ 107,961.69 ngenxa yokuthi amadoda angu-70 ayengaphansi kwesisu se-MRI kuphela, futhi amadoda angu-30 abe ne-biopsy elandelwe. Ngaphakathi kweqembu lamadoda kuphela eline-prostate i-MRI, amadoda angu-7 abe nemiphumela emibi engamanga futhi abangu-9 babe nemiphumela emibi. I-fusion jikelele ye-fusion biopsy ingadla amaphesenti angaphansi kwangu-25 kunokuthola i-biopsy engahleliwe.
Okushiwo lokhu: Ulwazi mayelana ne-prostate imaging emhlanganweni wonyaka we-urology ubonisa ukuthi i-MRI e-3T ehlukahlukene iveza kahle umdlavuza wezinga eliphezulu. Izinzuzo ngaphezu kwe-biopsy engahleliwe ziningi: Isibalo esincane sokuthola ukuthi sineBanga 6, izindleko eziphansi, amadoda ambalwa adinga ubuchopho kanye nezinkinga ezimbalwa ezivela ku-biopsy. I-caveat kuphela okufanele ikhumbule ukuthi i-mp-MRI eyenziwe ngendlela efanele idinga imishini ye-state-of-the-art kanye nodokotela abanolwazi, abaqeqeshwe kahle abafunda izikrini. Ngakho-ke, kuze kube yilapho lobu buchwepheshe buyanda kakhulu, ungase udingeke uhambe kwenye idolobha ukuze uqinisekise ukuthi uthola ukuskena kwakho enkabeni yobuhle.