Lapho ukuhlolwa kwegazi kwe- prostate-specific antigen (PSA) kuvunyelwa ngo-1994 njengethuluzi lokuhlola ukutholakala kokuqala komdlavuza wesifo sofuba, kwakunconywa njengendlela yokwelashwa engasindisa ukuphila okungenakubalwa.
Ngaphambi kwalokho, ukungabi nalendlela yokuthola ngendlela ehlelekile kwakusho ukuthi umdlavuza wesifo sofuba wawungakaze utholakale kuze kube yilapho usakazekele kwezinye izingxenye zomzimba, ukwandisa amathuba okuba ubhubhise.
Unyaka ngamunye kusukela isingeniso sohlolo lwe-PSA, izinga lokubulawa komdlavuza we-prostate liye lancipha, futhi amacala omdlavuza we-prostate ophezulu ngesikhathi sokuxilongwa awela ngamaphesenti angu-75.
Ukudideka nokuphikisana
Uzwakala njengendaba ephumelelayo, akunjalo?
Kodwa kancane kancane isizukulwane, ukuhlolwa kwe-PSA kuyinkinga yokudideka okukhulu nokuphikisana. Uthole ibanga elingaphumeleli kusuka kwiphaneli lokubukeza kwezokwelapha elicebisa ngokumelene nokusetshenziswa kwalo njalo, futhi kubonakala sengathi lingazange lithandeke odokotela abaningi neziguli eziningi.
Lokhu kwenzeke kakhulu ngoba i-PSA ithola kaningi kakhulu kancane ukwelashwa okungakabonakali ukulimaza, ukudalula ngokungadingekile amadoda amaningi ekukhathazeni, izindleko, kanye nezinkinga ezingase zibe khona zokwelapha umdlavuza.
Sifike kanjani lapha, futhi yiyiphi indima, uma ikhona, i-PSA enayo ekuhloleni komdlavuza we-prostate? Ingabe ukuhlolwa kusabalulekile?
Ukusetshenziswa Okufanele
Impendulo emfushane yalowo mbuzo wokugcina nguyebo.
Ukuhlolwa kwe-PSA kunganikeza ulwazi olubalulekile uma lisetshenziswe kahle.
Ngesikhathi mina kanye nabanye abadokotela be-urologists belana ngokukhathazeka ngokudlulela izifo zomdlavuza ezingezona ezibulalayo, abaningi bethu bacabanga ukuthi ukugxekwa kohlolo lwe-PSA kuye kwadlula.
Uma isetshenziswe ngendlela enengqondo, ukuhlolwa kusabalulekile. Ukuze uqonde lokho engikushoyo, ake sibuyele kancane futhi sihlole ukuthi yini eyenza isimo sethu samanje.
Amanqamu e-Indolent Cancer
Okokuqala, kubalulekile ukwazi ukuthi akuzona zonke izinhlobo zomdlavuza we-prostate ezifanayo.
Izikhumba eziningi zikhula kancane noma cha, futhi zibangele izimpawu ezincane noma ezingekho . Lezi zinhlamba zibizwa ngokuthi i-indolent.
Njengoba umdlavuza we-prostate kwenzeka ikakhulukazi emadodeni amadala-isilinganiso seminyaka esitholakalayo sokuthi uneminyaka engu-66-futhi njengoba ukwelashwa ngokuhlinzwa kanye nemisebe kungase ibe nemiphumela emibi engadingeki, njengokungabi namandla noma ukungahambisani nokuziphatha, into enengqondo yokwenza kulezi zimo ezikhula kancane nje gcina amehlo. Ithimba lezokwelapha kulokhu libhekwa ngokucophelela, okusho ukuhlola ngokuphindaphindiwe nokuhlola kabusha ukuhlukunyezwa komdlavuza.
Iziguli ezingamaphesenti angama-100 umdlavuza ongazange usakaze ngaphandle kwe-prostate yazo zihlala okungenani iminyaka emihlanu emva kokuthola isifo. Faka enye indlela, isikhathi esingathatha ngayo isifo sofuba se-indolent ukuqhubekela phambili futhi kubangele ukulimala kulezi ziguli uma kwenzeka njalo isikhathi eside kunokuphila kwabo okusele.
Amanqamu Aggressive
Ezinye izifo zomdlavuza we-prostate, kodwa zinobudlova, zikhula ngokushesha futhi zingaba zibulalayo. Kudinga ukwelashwa okufika ngesikhathi . Ngaphambilini zitholwa, kungcono izinkinga zokuphumelela.
Iziguli ezinesifo somdlavuza esisezintweni zaso kanye nezicubu eziseduze uma kuthiwa cishe ziphila eminyakeni emihlanu.
Kodwa labo abanesifo somdlavuza we-prostate basakaze ema-lymph node, amathanga, noma ezinye izitho zinezinga eliphuthumayo elingamaphesenti angama-29 eminyaka emihlanu yokusinda.
Ngakho-ke ungabona ukuthi kungani ukutholwa kokuqala kubalulekile. Kodwa yingxenye nje yempi. Ukukwazi ukubikezela inkambo yesifo somdlavuza wesiguli-ukwazi ukuthi kungukuthi kukhula kancane, akukho-action-edingekayo, uhlobo olusabekayo, olusasazekayo, noma into ephakathi-nakho kubalulekile.
Ukuthuthukisa Ukuhlolwa Kweminwe
Ngekhulu leminyaka lama-20, ukuphela komshini wokuhlola umdlavuza we-prostate udokotela wawunomshini wabo wokugcoba, ohloswe ngejubane-ukuhlolwa kwe-digital rectal, noma i-DRE.
Ukuhlolisisa isitho ngezibonakaliso zokukhulisa noma izimpumputhe kwanikeza isici sokuthi isifo sikhona yini. Kodwa kwakungeyona into eqondile, kwakungenakulungile, futhi ayikwazanga ukunikeza noma yiluphi ulwazi mayelana nenkambo yesifo somdlavuza. I-biopsy yezicubu zokuhlinzwa nezinye izivivinyo zokulandelela zazisetshenziselwa lokho kuzimisela.
Njengoba ungacabanga, ngenkathi isisu se-prostate sasinkulu ngokwanele ukuba sizwe, cishe sasiqhubekile kahle, okusho ukuthi cishe kwakungelapheki. I-DRE yayingeyona indlela ekahle yokuthola ekuqaleni.
Kwabe sekufika ukuhlolwa kwe-PSA. Ithola inani lamaprotheni okuthiwa i-prostate-specific antigen eyenziwa ngamaseli we-prostate gland futhi ejikeleza egazini.
Izinga le-PSA livame ukuphakanyiswa emadodeni anomdlavuza wesi-prostate. Ukuhlanganiswa kokuhlolwa kwe-DRE ne-PSA kuthuthukise kakhulu ikhono lethu lokubamba izicubu ze-prostate ekuqaleni.
Ama-Drawbacks we-PSA afaka phakathi i-Overnagnosis
Kodwa ukuhlolwa kwe-PSA kunamanani amaningi, futhi.
Okokuqala, ezinye izinto ngaphandle komdlavuza we-prostate zingabangela amazinga e-PSA ukuba aphakamise-izimo ezingenayo umdlavuza ezifana nokuvuvukala kwesisu noma ukukhulisa okwenzeka ngokuguga, isibonelo. Okwesibili, asikho i-PSA yezinga elicacile-elinqunyiwe. Amadoda amaningi anemiphumela ephezulu ye-PSA empeleni ayinayo umdlavuza wesicathulo, kuyilapho abanye benamazinga aphansi enza. Okwesithathu, amazinga "okukhohlisa amanga" aphezulu, okwenza ukhathazeke ngokungadingekile ezigulini ezingenayo umdlavuza. Futhi ekugcineni, ukuvivinywa kwe-PSA akukwazi ukuhlukanisa phakathi kwamanqamu okukhula okuphuza okudinga ukwelashwa nokuhlukumeza okwenzayo.
Ukwamukelwa kwe-PSA ukuvame ukuqala kokuhlola kusukela ngo-1990 kwakusho ukuthi ezinye izifo zomdlavuza we-prostate zitholakale ekuqaleni, ngaphambi kokuba kube khona izimpawu-into enhle kulabo abadinga ukwelashwa ngokushesha, kodwa hhayi okuhle kulabo abangazange bakwenze.
Izindleko zokusinda komdlavuza we-prostate zanda, kodwa nenani labesilisa abanezicubu ezingenasidingo ezingenakudingekile ukuthi babe nezidakamizwa, baqeda ukwelapha i-prostate, bekhuthazwa ukwelapha imishanguzo, futhi babhekana nemiphumela emibi yalezi zinqubo.
Izifundo ezimbili ezinkulu zilinganisela izinga lomdlavuza wesifo sofuba "ukuxilongwa ngokweqile" (ukutholakala kwesidumbu esingesongela ukuphila) ngenxa yemiphumela yokuhlola ye-PSA phakathi kwamaphesenti angu-17 no-50.
Futhi abacwaningi abatholanga ubufakazi obucacile bokuthi ukuhlolwa kwe-PSA ejwayelekile kwakuphethe ngokuqondile ukuhlaselwa okuphawulekayo ekubulaweni komdlavuza. (Ukunciphisa izinga lokufa komdlavuza wesi-prostate engikhulume ngakho esigabeni sesibili salesi sihloko kungenziwa ngenxa yezizathu eziningi, kufaka phakathi ukwelashwa okuthuthukisiwe .)
Amaqembu aphikisana mayelana nokuhlola
Ngakho-ke odokotela kanye neziguli ezishiywe ukulwa nazo kwakuyisivivinyo esibonakala njengesikhwama esixubene: Sithole eziningi zezinsana zomdlavuza, kungakhathaliseki ukuthi zidinga ukwelashwa noma cha, futhi zabonakala zingenzi kahle ngokwayo ekufeni kwabantu abanomdlavuza we-prostate.
Ngonyaka we-2008, i-US Preventive Services Task Force, iphaneli elinomthelela ochwepheshe ekunakekelweni okuyisisekelo kanye nemithi yokuvimbela (kodwa hhayi urology noma umdlavuza), kunconywa ukuthi amadoda angama-75 nangaphezulu angangeni ngaphansi kokuhlolwa kwe-PSA. Ngonyaka wezi-2012, iphaneli yandisa ukwelulekwa kwayo ngokumelene nokuhlolwa kwe-PSA ukufaka amadoda kuwo wonke ubudala, ethi ukulimala kokuhlolwa kunciphise izinzuzo zayo.
Amanye amaqembu ezokwelapha aphikisana, ephikisa ukuthi iziguli ezincane ezinezifo zomdlavuza ezingase zinyango kanye nalabo abasengozini enkulu (njengamadoda aseNtshonalanga kanye nalabo abanomlando womndeni wesifo somdlavuza we-prostate) bazoqhubeka bethola ngokuhlolwa kwe-PSA ejwayelekile. Baxwayisa ukuthi ukwehla ekuhlolweni kungabangela ukubuya ezinsukwini lapho umdlavuza wesifo sofuba ungatholakali kuze kube yilapho isigaba saso esiphakeme, esingenakuphulukiswa.
Ngaphandle kweziqondiso ezivunyelwene ngazo, odokotela neziguli babanjwa phakathi. Odokotela babevame ukushiya isinqumo sokuhlola iziguli zabo. Amazinga wokuhlola e-PSA awela, futhi kanjalo nokuthola izifo ze-prostate (futhi okungenakwenzeka).
Kodwa-ke, ngokukhathazayo, ucwaningo lwamuva lubike ukuthi inani lamathambo asanda kutholakala ekhanda lomdlavuza wesandulela ngculazi likhuphuke ngokunyuka kusukela ngo-2007. Nakuba sekukhona ukugxeka kwezindlela zokutadisha, akuyona into elula ukucabanga ukuthi ukuhlolwa komdlavuza ongaphansi kwesisindo kusho amacala amaningi amakhemikhali abalulekile futhi aphathwayo ngeke abanjwe aze asakaze.
Indlela Eyisisekelo Yokuhlola PSA
Ngakho kule ndawo edidekayo, yini isiguli okufanele senze? Ngokufanelekile, othile uzosungula ukuhlolwa kokuhlola okuhlakaniphile-okungekho nje kuphela okuchaza ngokusemthethweni umdlavuza wesandulela ngculazi kodwa ungakwazi ukubikezela ngokunembile inkambo yayo, ukucacisa ukuthi ungayiphatha kanjani nokuthi ungayiphatha kanjani.
Ngenhlanhla, kunezivivinyo zokuhlola okuthuthukisiwe emgqeni, kanye nezinye izinto ezifanele ukusiza ukuthuthukisa ukunemba kokuhlonza.
Okwamanje, nansi indlela yokuhlolwa kwe-PSA engiyincomayo nokuthi ngiyisebenzisa neziguli zami:
- Thola "i-PSA" ye-initial ye-PSA eneminyaka engu-50 ubudala. Udokotela wakho angalawula ukuhlolwa futhi axoxe ngemiphumela nawe. Uma umphumela wokuhlola, kuhlangene nomlando wakho wezokwelapha kanye neminye imininingwane yomtholampilo ibonisa ingozi ephansi yokuthuthukisa umdlavuza wesi-prostate, ukuhlolwa kwe-PSA okulandelwayo kufanele kuphindwe njalo njalo eminyakeni emihlanu.
- Uma ukuhlolwa kwe-PSA yakho yokuqala nolwazi lwezokwelapha eneminyaka engama-50 kubonisa ingozi ephakeme yesifo somdlavuza wesifo sofuba kodwa awunayo izimpawu, kufanele ube nokuhlolwa njalo ngonyaka usebenzisa enye yezinkinga zokuhlolwa kwegazi engizikhulunywe ekuqaleni (i-4Kscore noma i-Prostate Health Index ukuhlolwa ), futhi mhlawumbe i-MRI scan ye-prostate. Khuluma nodokotela wakho mayelana nalezi zinketho. Ngokusekelwe imiphumela yokulandelela yalezi zivivinyo, wena nodokotela wakho unganquma ukuthi yiziphi izinyathelo ezengeziwe, uma zikhona, ezidingekayo.
- Uma ngabe uneminyaka engama-60 izinga lakho le-PSA lingaphansi kwama-nanogram ama-2 nge-milliliter, amathuba okuba nomdlavuza wesifo sofuba obusondelene naso emncane kakhulu-1 noma 2 amaphesenti. Ngaleso sikhathi, kuphephile ukuphinda ukuhlolwa kwe-PSA kaningi kakhulu kunayo yonke iminyaka emihlanu noma ukuyeka ukuhlolwa ngokuphelele.
Ngalesi sindlela esivamile, sisaqhubeka sibamba umdlavuza wezinga eliphezulu odinga ukwelashwa kanti futhi kunciphise amathuba okuthola izicubu ezincane ezingenabungozi kodwa zingabangela ukukhathazeka okungenasidingo nokwelapha.
UDkt. Klein unguSihlalo we-Glickman Urological & Kidney Institute kaCleveland Clinic, uhlelo lukazwelonke lwe-Urology lwesizwe olubekwe yi- US News & World Report.
> Imithombo:
> Barocas DA, Mallin K, Graves AJ, et al. Imiphumela ye-USPSTF yeBanga D Ukuncoma ngokumelene nokuhlolwa kwesifo se-Prostate kwi-Incident Prostate Cancer Findings in the United States. J Urol . 2015 Dec; 194 (6): 1587-93.
> Barry MJ, uNelson JB. Ukuphikiswa Okuphikisayo: Iziguli ziletha nge-Cancer Advanced Prostate Cancer kusukela USPSTF Screening Recommendations. J Urol . 2015 Dec; 194 (6): 1534-6.
> Catalona WJ, D'Amico AV, ama-Fitzgibons WF, et al. Okushiwo yi-US Force Preventive Services Task Force ekunconyweni kokuhlolwa komdlavuza we-prostate. U-Ann Intern Med . 2012 Jul 17; 157 (2): 137-8.
> Moyer VA, LeFevre ML, Siu AL, et al. Ukuhlolwa kwesifo somdlavuza we-prostate: Isitatimende sezincomo se-US Preventive Services Task Force. U-Ann Intern Med . 2012 Jul 17; 157 (2): 120-34.
> Ukuqapha, i-Epidemiology, ne-End Results (SEER) I-Stat Stat Fact Sheets: I-Cancer Prostate. I-National Cancer Institute. Kufinyelelwe ku-http://seer.cancer.gov/statfacts/html/prost.html