Ngesikhathi ngiqeqeshwe ukuba ngudokotela we-urologist eminyakeni yama-1980, ukuhlolwa kwegazi kwe - PSA manje esiyisebenzisayo ukuhlola umdlavuza wesi-prostate kwakungakafiki, futhi ukuthola isifo se-prostate kwakuyinhloko yengozi.
Odokotela kungenzeka ukuthi kwenzeka okwenqabelayo lapho behlola isicathulo sesiguli sabo ngomunwe wenkomba ngesikhathi sokuhlolwa kwesimiso ( ukuhlolwa okubukeka kabi kwe- digital rectal ), noma ukuxilongwa ngemva kwezimpawu ekugcineni kwaholela umuntu ukuba alungise ukuqokwa kukadokotela ukuthola ukuthi yini engalungile.
Akuyona into enhle yokubamba umdlavuza wesi-prostate ekuqaleni kwawo, isigaba esinesifo esihle kakhulu.
Eminyakeni engamashumi amathathu edlule, ingxenye yesifo esanda kutholakala yayibandakanya umdlavuza wesifo sofuba owawuvele usakazekele kwezinye izingxenye zomzimba ngesikhathi sitholakale. Ukuhlinzwa kaningi komdlavuza we-prostate engangiwenza njengomuntu ohlala e-urology wasusa ama-patient's testicles-umzamo wokwelapha umdlavuza ophuthumayo ngokubulawa yindlala ye-testosterone ukuthi izidumbu zisebenzise njengamafutha.
Amapulani we-PSA
Ukufika kokuhlolwa kwe- PSA kuma-1990s kusisize ukuba senze ukuhlolwa kwe-cancer ye-prostate ngokubanzi ngendlela efanayo esibheka ngayo amazinga aphezulu e-cholesterol njengendlela yokubonisa isifo senhliziyo. Izigidi zabantu ziye zahlolelwa, futhi imiphumela isisize ukuba sibone izicubu ezilimazayo ezingaphathwa ngendlela efanele, njengoba isipiliyoni sika-Ben Stiller senze umbukiso.
Ukuhlolwa kwe-PSA eneminyaka engama-50 kungabonisa ingozi yomuntu yokudala umdlavuza wesifo sofuba futhi usize yena nodokotela wakhe banqume ukuthi ukuhlolwa okumele kwenziwe kaningi kangakanani.
Uma ukufundwa kungaphansi kwe-nanograms / milliliter engaphansi kuka-0.7 (isilinganiso samanani ezineminyaka engu-50 ubudala), ingozi yokuphila komdlavuza wesi-prostate ingaphansi kwamaphesenti angu-10 futhi ukuhlolwa kwe-PSA esizayo cishe kuyadingeka njalo eminyakeni emihlanu. Uma izinga lingaphansi kwama-nanogram / i-millilitha engaphansi kwe-2 eneminyaka engama-60, ingozi yokuthola umdlavuza wesifo sofuba obusongela ukuphila noma ukufa kwayo ingamaphesenti angama-2 kuya kwangu-3 kuphela, kanti ukulandelwa kwe-PSA ukuhlolwa kunganciphisa noma kuqedwe.
Amaminithi we-PSA
Ngenkathi ukuhlolwa kwe-PSA kunenani elikhulu, akunakwenzeka ngokuphelele . Ilinganisa inani lamaprotheni okuthiwa i-prostate-specific antigen, noma i-PSA, ejikeleza egazini. I-PSA yenziwe ngamaseli ku-prostate gland. Nakuba izinga le-PSA eliphakeme lingase libe ngenxa yomdlavuza, izinombolo nazo zingakhuliswe nezinye izimo zezokwelapha, ezifana nezifo kanye nokukhuliswa okunamandla kwe-prostate okwenzeka njengabantu abadala. Ngisho nokukhuphuka kwePSA okukhulu, kusukela ekuhlolweni olulodwa kuya kwesinye-isilinganiso esibizwa ngokuthi i-PSA velocity-akuyona inkomba enokwethenjelwa yodwa ebukhosini bomdlavuza we-prostate.
Ngaphezu kwalokho, asikho i-PSA level "ejwayelekile" ecacile. Amadoda amaningi anamazinga aphezulu e-PSA egazini lawo empeleni ayinayo umdlavuza wesibeletho, kuyilapho abanye abanezinga eliphansi le-PSA enza. Kukhona nobufakazi bokuthi amazinga we-PSA nezinye izici ze-PSA zihlukile kubantu base-Afrika-Amerika kunabamhlophe.
Ngenxa yalokhu kungabonakali, amanye amadoda angenawo isidakamizwa sokuhlinzeka nge-biopsy yokuhlinzeka ngokungadingeki futhi angaqeda ukuthola imithi yokwelashwa engadingekile, kanti amanye amadoda adinga ukwelashwa awahlolwanga ngokushesha.
Inkinga Yokubikezela
Okokugcina, imiphumela ye-PSA yedwa ayikwazi ukubikezela inkambo yomdlavuza we-prostate yesikhathi esizayo.
Ama-tumor amaningi we-prostate ayingozi kakhulu, akhula kancane, angabangela izimpawu ezimbalwa noma azikho, futhi akadingi ukwelashwa. Ezinye izicubu zikhula ngokushesha futhi zingasakazeka ngokunye kwezinye izindawo zomzimba. Ngokusobala singathanda ukwazi ukuthi yiluphi uhlobo lomdlavuza isiguli esinazo ukuze senze izincomo zokwelashwa ezifanele, kodwa amazinga e-PSA asisizi ngalesi sigwebo.
I- prostate biopsy , ehlunga izicubu ezivela ezindaweni ezisolisayo zokuhlola i-laboratory, ingasiza ukuhlukanisa izicubu njengezinga eliphansi, eliphakathi, noma eliphakeme ngokusebenzisa isigaba esibizwa ngokuthi yiGleason score, kodwa i-subjective futhi ayisho njalo ukuhlukumezeka kwangempela komdlavuza.
Futhi iphuzu lokuhlolwa okuhle kokuhlola ukuhlola ukunciphisa isidingo sama-biopsies, njengoba bengakhululekile, kubangele ukukhathazeka futhi kungaba nemiphumela emibi.
Izindaba ezinhle ukuthi ukuhlolwa kokuhlola okuthuthukisiwe namanye amathuluzi okuhlonza kuyatholakala, okumele kusisize "ngomdlavuza / hhayi umdlavuza" kanye nezinqumo "ezikhula kancane / ezimbi". Ake sibheke.
Izivivinyo zokuhlola ezibukhali
Izivivinyo eziningana zokuhlola emakethe ziye zaboniswa ukuthi zinembile kakhulu kunesivivinyo se-PSA ekutholeni ukutholakala noma ukungabikho komdlavuza wesifo sofuba, futhi ekutholeni ukwelashwa okuphezulu okumele kubekwe ukwelashwa. Zisetshenziswa ngokuhlanganyela-hhayi esikhundleni se-PSA ukuhlolwa, futhi zenzelwe ukusiza iziguli nodokotela banqume ukuthi ngabe i-biopsy iyadingeka ngemuva komphumela wokuhlola we-PSA ophakeme.
Ukuhlolwa kwegazi noma komchamo kuhlanganisa i-4Kscore ™ , i-Prostate Health Index, i-Mi-Prostate Score, ne-ExoDx ® Prostate (IntelliScore). Ngamunye uhlaziya inhlanganisela eyingqayizivele, eyimfihlo yama- biomarker , noma izinkomba eziphilayo, zomdlavuza. Abanye baphinde balinganise i-PSA, kodwa ngezindlela ezahlukene kunokuhlola okujwayelekile. Isibonelo, ukuhlolwa (okwamanje okwamanje kungatholakali kwezohwebo) okuthiwa i-IsoPSA ™ eyakhiwe yiCleveland Clinic neCleveland Diagnostics, Inc., ifuna izinguquko ezihlukile emkhathini wamaprotheni we-PSA.
Nakuba izivivinyo ezintsha zokuhlola zinciphisa ama-biopsies angadingekile, noma i-Medicare noma abanomshwalense abazimele njengamanje ngeke bakhokhele ngesimiso (ezinye izithwali zingazifaka emakethe zendawo) -i-carryover, mhlawumbe, ngokukhathazeka kwabo kwangaphambili ukuthi ukuhlolwa kwe-PSA nakho kuthole ama-cancer amaningi aphansi abangeke adinge ukwelashwa. Iziguli zingase zithwale izindleko, okungaba yizinkulungwane ezingamakhulu zamaRandi.
Lezi zivivinyo ziyasiza ezimweni lapho kungabonakali khona uma i-PSA ekhulayo ibonisa umdlavuza, futhi kuziguli ezinePSA ekhulayo kanye ne-biopsy eyayibi ngaphambili.
Indlela Yokuphikisa Ngcono
Kubantu abanemiphumela engavamile kusuka kulezi zivivinyo, isinyathelo esilandelayo yi-biopsy. Kule nqubo sithatha amasampula ama-prostate tissue we-pathologist ukuhlola ngaphansi kwe-microscope ukuthola ukuthi umdlavuza ukhona yini. Kube khona ukuthuthukiswa kwamuva, ukwamukelwa lapha, futhi.
Ukuze uthole amasampula amathishu, senza uchungechunge lwezinaliti (kusuka ku-12 kuya ku-24) zibe izingxenye ezihlukahlukene zegland, eholwa yi-scanning ye-ultrasound. Sisebenzise le ndlela kusukela ngawo-1980. I-prostate encane, ngobukhulu be-walnut, izithombe ezinjalo ze-ultrasound zisisiza ukuba sibeke kahle izinaliti. Kodwa lezi zithombe azitholakali ngokwanele ukuthi sitshele izindawo ezisolisayo, ezingase zibe nomdlavuza kusuka ezicubu ezivamile.
Iqiniso liwukuthi sisebenzisa inqubo ye-scattershot, sinethemba ukuthi, uma isisu sikhona, okungenani enye yezilenge izohlangana nayo. Lezi zinhlobo ze-biopsies ezingahleliwe zingaphuthelwa izicubu ezithile eziyingozi, kuyilapho ziveza ezinye ezingenakuqhathaniswa futhi zingaqeda ukuphathwa ngokungadingekile.
Ngenhlanhla, i-MRI scan ebizwa ngokuthi i-multiparametric MRI ingakwazi ukuhlukanisa phakathi kwezicubu ezinamahloni ezinobuthi nezibi.
Kungaba nzima ukwenza i-biopsy ngenkathi isiguli singaphakathi kwesithwebuli se- MRI . Kodwa akudingeki. Isofthiwe entsha isenza sihlanganise, noma fuse, lezo zici ze-MRI ezihlukahlukene eziningiliziwe ezinemifanekiso ebukhoma, yangempela yesikhombisa ukuqondisa izinaliti ze-biopsy. Isiguli kuqala sibhekana ne-MRI. I-radiologist iyihlola futhi iveza izindawo ezisolayo. Kamuva, esimweni sokuhlinzeka ngeziguli eziphuthumayo, sifaka iprobhethi ye-ultrasound engxenyeni yesiguli, eduze ne-prostate.
Isofthiwe ye-fusion ihlanganisa i-MRI ekhona ngaphambili futhi ibuke izithombe ze-ultrasound. Njengoba sisusa isimiso se-ultrasound esiseduze ne-prostate, isofthiwe ishintsha umfanekiso we-MRI ngokufanele, isinike umbono obanzi, 3-D. Singasebenzisa lesi sithombe esifakiwe ukuze sibheke izinaliti ze-biopsy esiqhingini esizifunayo ukusampula kunokuba sizungeze futhi sithemba ukuthi sithola okuthile. Kufana nokusebenzisa i-GPS yakho ye-smartphone ukufinyelela indawo okuyo kuyo esikhundleni sokushayela ngaphandle kwekhombandlela.
Inselele ngale ndlela, ebizwa ngokuthi i-MRI / transrectal ultrasound (TRUS) i-biopsy eqondiswa ukufutha, futhi iyabiza. I-scan isinganiselwa ku-$ 1,500 futhi izinkampani zomshuwalense ngokuvamile ngeke zikhokhelwe ezigulini ezine-biopsy yazo yokuqala. Bazosimboza uma kusetshenziselwa ukuphikisana kwe-biopsy noma iziguli eziye zatholakala ukuthi zinomdlavuza we-prostate.
I-biopsy eqondiswe nge-Fusion ayilungile. Ucwaningo oluthile oluthola ukuthi lulahlekelwa cishe izicubu eziningi ze-prostate njengoba kwenza i-biopsy ejwayelekile. Kodwa amakhemikhali aphuthelwa kakhulu amathuba okuba angabalulekile emitholampilo engadingi ukuphathwa. Futhi i-biopsy eqondiswa i-fusion ibuhle kakhulu ekuboneni izicubu ezinokuhlukumezeka.
Ukubikezela Amanqamu Aggressive
Ukuze usisize nakakhulu ngaloluhlolo, kunezivivinyo ezintsha ezingakwazi ukuhlaziya izicubu ze-biopsy ngezibonakaliso zegciwane lesingozi kakhulu. Lezi zivivinyo zomzimba-i-Oncotype DX ® Genomic Prostate Score, i-Decipher ® I- Prostate Cancer Classifier, i-ProMark ® Proteomic Test Prognostic kanye ne-Prolaris ® test-bheka ukungazinzi kwe-DNA okuphawulekayo kwezidumbu ezikhulayo.
Ngaphezu kwalokho, izivivinyo ze-Oncotype DX kanye neProMark zingakwazi ukubikezela ukuthi kunomdlavuza owingozi kakhulu ukufihla kwenye indawo ku-prostate, ezindaweni ezingazange zithathwe izinaliti ze-biopsy. (I-Cleveland Clinic yasize ithuthukise i-Oncotype DX futhi yahlanganyela ekucwaningeni okuqinisekisile i-Decipher ne-ProMark.)
I-Medicare kanye nezinye izinkampani zomshuwalense zimboza izindleko zalezi zivivinyo zokubikezela iziguli ezitholakalayo izifo ezithinta izifo (i-Gleason izikolo engizikhulumile ngaphambili) zikhombisa ukuthi kunezicubu ezincane kakhulu noma ezisezingeni eliphansi kakhulu. Ngokujwayelekile abakhokhi ukuhlolwa kokubikezela ezimweni lapho izikolo zeGleason zibonisa izicubu eziphakathi nendawo noma eziphezulu.
Ngemiphumela yalezi zivivinyo zofuzo, odokotela neziguli bangenza izinqumo ezinolwazi mayelana nendlela yokuqhubeka-noma ukwelashwa okusheshayo njengokususwa kokuhlinzwa kwe-prostate, noma ukubhekwa okusebenzayo, okusho ukuhlola ngokuphindaphindiwe nokuhlola kabusha isimo somdlavuza.
UDkt. Klein unguSihlalo we-Glickman Urological & Kidney Institute kaCleveland Clinic, uhlelo lukazwelonke lwe-Urology lwesizwe olubekwe yi-US News & World Report.
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