Kunezithiyo eziningi zokuthola ukunakekelwa okuphelele komdlavuza wesi-prostate . Okokuqala, njengoba sizobona ngasekupheleni kwalesi sihloko, umdlavuza wesifo sofuba uyingqayizivele, okusho ukuthi ukunquma ukwelashwa okufanele kakhulu kungaba nzima. Okwesibili, inani elingenamkhawulo lokwaziswa okungahleliwe nokuphelelwa yisikhathi kwi-Intanethi luyinkimbinkimbi futhi alinakugwenywa. Odokotela , bengazivumeli iziguli, baphele amandla.
Okwesibili, isikhathi sokuhlangana phakathi kweziguli nodokotela silokhu sinciphisa ngenxa yokwanda kwebhizinisi elikhulu nohulumeni ekunakekeleni ukwelashwa. Ngaphezulu kwalezi zinkinga, cabanga ukuthi kungabikho odokotela abaqaphele ekukhetheni ukwelashwa . Benza ngokukhethekile ukuhlinzekwa noma ukushisa imisebe, ngakho-ke inqubo yokwenza izinqumo ishiyelwa kwesiguli.
Ingabe iziguli kufanele zikhethwe ngokukhetha uhlelo lokulashwa?
Odokotela abathintekayo iziguli zomdlavuza we-prostate bazizwele ukulinganiselwa okubalulwe ngenhla. Futhi bayaqaphela ukuthi kunezinye izinkinga futhi. Owokuqala wukuthi odokotela banenkinga enkulu yokukhathazeka. Zikhokhwa ukwenza kuphela uhlobo olulodwa lwezokwelapha, ukuhlinzwa noma ukushiswa kwemisebe . Ngenxa yalokho, abakwazi ukunikeza izincomo zokwelashwa ezinamandla. Iziguli zizwa kangaki udokotela wazo, "Kudingeka ube yilowo okhethayo"?
Okwesibili, ukubikezela ukuthi isifo somdlavuza wesiguli singathí sina kakhudlwana ngumdlavuza we-prostate.
Kuthatha iminyaka eyishumi ukuthi umthelela wesinqumo sokwelashwa ufezeke. Izibikezelo zithinteka kakhulu yi-profile esebekhulile yeziguli zomdlavuza we-prostate. Ukufa kusukela ekugugeni kuvamise ingozi enkulu kunomdlavuza ngokwawo. Okokugcina, kumongo walomdlavuza omnene, okhula kancane, umthelela wezokwelapha ngekhwalithi yokuphila-izinto ezinjengokuntula amandla noma ukungaziphathi-kungase kube mkhulu kunomthelela ekusindeni.
Ubani ongcono okulinganisela ukulinganisela izinto eziphambili zezinga eliphezulu lempilo ngokusinda kunesiguli?
Ukwazi Isigaba Sakho
Ukubamba iqhaza kwinkqubo yokukhetha ukwelashwa kungenakugwema iziguli zomdlavuza we-prostate. Ukukhethwa kokwelapha kuhambisana nesigaba somdlavuza, iminyaka yesiguli, kanye nezinhloso zakhe zempilo. Ngenxa yalokho, ukwazi isigaba somdlavuza kubalulekile:
- Linciphisa inani lezinketho zokwelashwa futhi ligwema isidingo sokuhlunga inani elikhulu lokwaziswa okungadingekile.
- Ithuthukisa ukukhulumisana ngesiguli nodokotela. Odokotela bangakwazi ukweqa izincazelo eziyisisekelo mayelana nesigaba futhi bafinyelele ekuxoxweni okuqhathanisa mayelana nemithi ejwayelekile kakhulu esetshenziselwa isigaba esithile salo muntu.
- Iyindlela engcono kakhulu yokuthola umbono onembile weengozi yomdlavuza kanye nokuphuthuma (noma ukungabi khona kwayo) ukwelashwa okunamandla (bheka ngezansi).
Izinyathelo Ezinhlanu ZeBlue
Kunezigaba ezinhlanu ezinkulu zomdlavuza we-prostate- I- Sky, Teal, Azure, i-Indigo, iRoyal- each ephethe ama-subtypes amathathu okuthiwa aphansi, ayisisekelo nephezulu , ngamazinga angu-15. Izigaba ezintathu zokuqala, izulu, i-Teal, ne- Azure , zifana nezigaba ezijwayelekile zezinhlekelele zezifo eziphansi, eziphakathi nendawo eziphezulu ezakhiwe ngu-Anthony D'Amico waseHarvard Medical School.
I-Indigo neRoyal imelela umdlavuza we-prostate ovulekile futhi othuthukile , ngokulandelana. Kunamanye amahlelo wesiteji eziningana, kodwa bonke banamaphutha. Izigaba zeBlue kuphela kuphela ezimele umthamo ogcwele we-cancer yomzimba.
Ingozi Yokufa Emdlavuza We-Prostate
Enye yezinzuzo ezinkulu kunazo zonke zokuthi isiteji sinikeza ukuthi siqonde ukungathí sina kwesifo, okuyisinye sezici ezibaluleke kakhulu ekunqumeni ukwelashwa okulungile. Ukwelashwa okunamandla kumele kufane nokuhlukunyezwa kwesifo. I-Cancer elula ifanele ukwelashwa okuncane. Amanqamu ahlukumezayo adinga ukwelashwa okunonya.
Ukubekezelela imiphumela yocala ehlobene nokwelashwa akuvumelekile uma umdlavuza ubumnene, kanti neminye imiphumela emibi ingamukelwa lapho kutholakala isifo esisongela ukuphila. Ithebula 1 likhombisa ukuthi ingozi yokufa ihluka kanjani phakathi kwezigaba.
Ithebula 1: Ingozi Yokufa Ngesiteji
Isiteji seBlue | I-Degree ye-Treatment Intensity iphakanyisiwe | Ingozi Yokufa | % seSigaba ngasinye esitholakalayo |
I-Sky | Akukho | <1% | 50% |
Teal | I-moderate | 2% | 30% |
I-Azure | I-Maximal | 5% | 10% |
Indigo | I-mod. KuMax. | <50% | 0% |
Royal | I-Maximal | > 50% | 10% |
Inothi elibalulekile: Ithebula elingenhla libonisa ukuthi izinga lokwelashwa okuphakanyisiwe ngamaphesenti angama-80 amadoda asanda kutholakala (I- Sky neThebula ) kungenzeka ukuthi ilinganise noma ayikho.
Isikhathi Sokufa Kusuka Emdlavuza We-Prostate
Umdlavuza we-prostate uziphatha ngokuhluke kakhulu kwezinye i-cancer, ikakhulukazi lapho ukhula kancane. Ngokwesibonelo, ukufa okuvela emdlavuza wamaphaphu noma umdlavuza we-pancreatic kungenzeka ngonyaka wokuqala wokuxilongwa. Ukujwayela kwethu ngalezi zinhlobo ezimbi zesifo somdlavuza kuchaza ukuthi kungani igama elithi "umdlavuza" lidala ukubola okukhulu. I-Cancer, sicabanga, ihambisana nokufa okuseduze. Kodwa bheka ukuthi izibalo ezikuThebula 2 zibonisa kanjani indlela ehlukile ngayo umdlavuza wesibeletho.
Ithebula 2: Amanani Okusinda I-Cancer Yokuthola Ingculazi Entsha
Isilinganiso sokusinda | Usuku Lokuqala Lokwaziswa | |
Unyaka ongu-5 | 99% | 2012 |
Unyaka ongu-10 | 98% | 2007 |
Unyaka ongu-15 | 94% | 2002 |
Eminyakeni engaphezu kwengu-15 | 86% | Ekupheleni kuka-1990 |
Cabanga ukuthi amazinga okusinda angathathwa kuphela ngokuhamba kwesikhathi; Ukufa kweminyaka engu-10 kungabalwa kuphela emadodeni aphinde atholakala emuva ngo-2007, futhi ngamazinga anamuhla, ukwelashwa ngaleso sikhathi kwakunqatshiwe. Ngakho-ke, izibalo zokusinda ezithembele kubuchwepheshe obudala kungenzeka ukuthi azimele amathemba omuthi owelashwa namuhla. Izinga lokusinda lizoqhubeka liba ngcono ngesikhathi, futhi, uma ngabe kukhona, abantu abanomdlavuza we-prostate okhula kancane kancane banesikhathi.
Ezinye izinhlelo zokuThintana aziphelelanga
Lapho abantu bebuza odokotela babo, "Ngisiphi isigaba?" Ngokuvamile abaqapheli ukuthi kunezinhlelo eziningi ezihlukahlukene zokusetshenziswa kweziteji ezisetshenziswayo. Ake sibuyekeze kabili ezinye izinhlelo zesiteji:
- Iziteji zemitholampilo (A, B, C, noD) zibhekisela ngokuqondile ukuthi i-prostate izwa kanjani ekuhlolweni kwe-digital rectal (DRE). Loluhlelo lwasungulwa ngaphambi kokuthi i-PSA isungulwe futhi isetshenziselwa abahlinzayo ukuba banqume ukuthi ukusebenza kwe-prostatectomy enamandla kuyamukeleka yini (Bheka ithebula 3).
- Isiteji se-pathologic sibhekisela kumkhawulo womdlavuza owenziwe ngukuhlinzwa noma nge-biopsy.
- I-TNM Isiteji sihlanganisa ulwazi oluvela kokubili 1 no-2 kanye nokwaziswa okutholakala ematheni we-bone noma ama-CT scan.
- Umkhakha wesigaba sengozi, ohlukanisa amadoda asanda kutholakala abe yizigaba eziphansi, eziphakathi, futhi eziphezulu, usebenzisa ulwazi oluvela ku-1 no-2 kanye nezinga le-PSA.
Ithebula 3: Isigaba seMitholampilo (Isigaba se-DRE)
Isiteji | Incazelo |
I-T1 : | I-tumor engakwazi ukuzwa nhlobo ngu-DRE |
I-T2 : | I-tumor ivalwe ngaphakathi kwe-prostate I-T2a: I-Tumor ku-<50% ye-lobe eyodwa I-T2b: I-Tumor ku-50% ye-lobe eyodwa kodwa hhayi kokubili lobes I-T2c: I-Tumor yazizwa kokubili i-lobes |
T3 : | I-tumor eyenza i-capsule capsule I-T3a: isandiso se-Extracapsular I-T3b: I-tumor ehlasela ama-vesicle (s) |
I-T4 : | I-tumor ehlasela i-rectum noma isinye |
Izingxenye zezinyathelo zeBlue
I-Stage of Blue system isebenzisa zonke izinhlelo zesiteji (1, 2, 3 no-4 ezibalwe ngenhla), futhi kufaka phakathi ulwazi mayelana nokuthi ukuhlinzeka kwangaphambili noma ukushiswa kwemisebe kwenziwe.
- Ukuhlolwa kwe-rectal Digital: Normal vs. nodule vs. mass
- Isilinganiso seGleason : 6 vs. 7 vs. 8-10
- I-PSA: <10 vs. 10-20 vs. 20
- Ama-cores we-Biopsy: Okumbalwa kuqhathaniswa nesilinganiso esilinganisene nasobaningi
- Ukwelashwa kwangaphambilini: Yebo ngokumelene no
- Ukucabanga: Isibalo sesifo, kungakhathaliseki ukuthi sise-lymph nodes noma amathambo
Ungakwazi ukucacisa isiteji sakho ku-intanethi kwiwebhusayithi ye-PCRI ngokuphendula imibuzo emfushane embuzo ku-stagingprostatecancer.org.
Yini Engalungile Ngesimiso Sokubeka Isigaba Sengozi?
Isistimu yesigaba sengozi, esakhiwe yizingxenye ezintathu eziphezulu ohlwini lwamacupha angenhla, alufaki eziningi zezinto ezibalulekile ezibalulekile ezithuthukisa ukunemba kwesiteji:
- Okutholakele kwe-Multiparametric-MRI
- Iphesenti yezinhlamvu ze-biopsy eziqukethe umdlavuza
- Ulwazi lwe-PET lokuskena
Ngaphezulu kwalokho, uhlelo lwesigaba sengozini alubandakanyi amadoda avuselele izifo, amadoda ane-hormone resistance, noma amadoda ane-metastases emathanjeni.
Uma Ukwazi Isigaba Sakho, Iyiphi Imithi Eyingozi?
Ukubaluleka okukhulu kokwazi isiteji sakho ukuthi kuvumela iziguli nodokotela ukuthi bangene ezindaweni ezikhethwa kakhulu zokwelashwa. Esikhathini esisele salesi sihloko, ezinye izinketho zokwelashwa eziqondene nesigaba ezethulwa kuzo zonke izigaba.
I-Sky
Njengoba i- Sky (Low-Risk) yinhlangano engenabungozi, futhi njengoba manje sesiyazi ukuthi uGleason 6 akakaze asebenze, ukubiza ngokuthi "umdlavuza" kuyiphutha eliphelele. Ngokufanele, i-Sky izobizwa ngegama eliyisifo esinomsoco kunokuba nomdlavuza. Ngakho-ke, zonke izinhlobo ezintathu ze- Sky , ( Low, Basic and High) ziphathwa ngokubhekwa okusebenzayo. Ingozi enkulu kubantu besesibhakabhakeni ukuhluleka ukuthola isifo esiphezulu se-occult. Ngakho ukuskena ngenkuthalo nge-MRI multiparametric esikhungweni somdlavuza onolwazi kunengqondo.
Teal
I-Teal (Intermediate-Risk) yisimo esiphansi sebanga eliphansi kanye nethemba elihle lokuhlala isikhathi eside. Nokho, iningi lamadoda lidinga ukwelashwa. Okuhlukile yi- Low-Teal , okuyinto ukubhekwa okusebenzayo kuyamukeleka. Ukufaneleka njenge- Low-Teal i -Gleason kumele ibe yi-3 + 4 = 7, hhayi i-4 + 3 = 7, inani leBanga le-4 ku-biopsy kufanele libe ngaphansi kwamaphesenti angu-20, ama-3 kuphela noma ama-biopsy ambalwa kuphela angaba nomdlavuza kungaba ngaphezu kwamaphesenti angama-50 esikhundleni somdlavuza, futhi konke okutholayo kufanele kufane ne- Sky .
I-Basic-Teal inezinhlamvu eziningi ezinomdlavuza kune- Low-Teal, kodwa kusengaphansi kuka-50 okwamanje. Amadoda anama- Basic-Teal angamalungu angama -artificial single treatment therapy noma ngabe yiziphi ezinye izindlela zokwelashwa zanamuhla, kuhlanganise nemithi yokufaka imbewu, i-IMRT, ukwelashwa kweproton, i-SBRT, ukwelashwa kwe-hormone, nokuhlinzwa.
I-High-Teal ihlanganisa noma yikuphi okubekiwe kwe-criteria ye- Teal isiguli esingahambi ku- Low noma Basic . I-High-Teal inamandla kakhulu futhi kufanele ilashwe nge-combination combination efaka i-IMRT, imbewu, kanye neyezinyanga ezine kuya kweyisithupha izifundo zokwelashwa kwe-hormone.
I-Azure
I-Azure (High-Risk) ibuye iqukethe ama-subtypes amathathu. I-Low-Azure i-Gleason 4 + 4 = 8 enezinhlamvu ezimbili noma ezimbalwa ze-biopsy, akukho nhlobo ye-biopsy engaphezu kwama-50% abathintekayo ngomdlavuza, nazo zonke ezinye izinto ezifana ne- Sky . Amadoda ane- Low-Azure aphathwa ngendlela efanayo ne- High-Teal.
I-Basic-Azure yilona uhlobo oluvame kakhulu lwe- Azure futhi limelela noma yiluphi isigaba se- Azure esingakwazi ukuhlangabezana nemigomo ye- Low noma ephezulu . I-Basic-Azure iphathwa nge-radiation, imbewu, ne-hormone therapy izinyanga ezingu-18.
I-High-Azure ichazwa njengeyodwa noma ngaphezulu kwalokhu okulandelayo: PSA ngaphezulu kuka-40, i-Gleason 9 noma engu-10, ngaphezulu kwamaphesenti angama-50 we-biopsy cores, noma umdlavuza emasongweni okugulisa noma ama-node. I-High-Azure iphathwa ngendlela efanayo ne- Basic-Azure, nakuba kungenzeka nge-Zytiga, Xtandi, noma i-Taxotere.
Indigo
I-Indigo ichazwa ngokuthi umdlavuza uphinde uphinde uphethwe ngemuva kokuhlinzwa noma imisebe. Kungakhathaliseki ukuthi i- Indigo iphansi , i-Basic noma i- High inqunywa ukuthi kungenzeka umdlavuza usakazeka emagqumeni ase-pelvic. I-Low-Indigo isho ukuthi ubungozi buphansi. Ukuze ufaneleke njenge- Low-Indigo, i -PSA kufanele ibe <0.5 emva kokuhlinzwa kwangaphambilini noma <5.0 ngemuva kwemisebe yangaphambilini. Futhi, isikhathi se-PSA sokuphindaphinda kufanele sibe> izinyanga ezingu-8. Ngaphezu kwalokho, isigaba sokuqala seBlue ngaphambi kokuhlinzwa noma ukushiswa kwemisebe kwakufanele kube yi- Sky noma iTeal . Ukwelashwa kwe- Low-Indigo kungase kube nomswakama (emva kokuhlinzwa kwangaphambilini) noma salvage cryotherapy (ngemuva kwemisebe yangaphambilini).
I-Basic-Indigo isho ukuthi ukutholakala kwesikhala kanye nokutholakala kwamathambo akubonisi amangqamuzana ahlanganisiwe (abizwa ngokuthi ngamamitha), kodwa izinqubo ezikhethiwe ezibalwe ngenhla ze- Low-Indigo azihambisani. Ngamanye amazwi, okukodwa noma ngaphezulu kwezici ezihlukahlukene kubonisa ukuthi amamineramu amakhulu angama-pelvic angase abe khona. Ukuze uthole i- Basic-Indigo , ukwelashwa okuhlanganyelwe okunamandla nemisebe ye-nodes kanye ne-hormonal therapy kufanele isetshenziswe.
I-High-Indigo kusho ukuthi imithi ikhonjiswe ukuthi ikhona emigqumeni ye-lymph nodes. Ukwelashwa kwe- High-Indigo kufana ne- Basic - Indigo ngaphandle kokuthi ukwelashwa okwengeziwe ngeZytiga, Xtandi, noma i-Taxotere kungacatshangwa.
Royal
Amadoda aseRoyal angaba ne-hormonal-resistant (i-PSA ekhulayo ne-testosterone ephansi) noma ama-metastases angaphandle noma angaphandle kwamakhadi we-pelvic (noma kokubili). I-Low-Royal iyi-"ehlanzekile" yokumelana ne-hormone ngaphandle kwemithi ebonakalayo. Laba besilisa cishe banesifo esincane semithambo yezinsalela kodwa kungenzeka ukuthi akunakwenzeka ukubona ngethambo elijwayelekile noma ucwaningo lwe-CT. I-PET entsha, enamandla kakhulu efana ne-Axumin, i-PSMA, noma iCarbon 11 ingadingeka ukuthola imetastases. Uma sekutholakala i-metastases, ukwelashwa kuzofana ne- Basic-Royal .
I-Basic-Royal ingukuthi okungenakwenzeka kwezifo ze-metastatic (ngaphandle kwesikhumba) kodwa inani eliphelele lama-metastase liyisihlanu noma ngaphansi. Ukwelashwa kwe- Basic-Royal kuyinhlanganisela ye-SBRT noma i-IMRT kuzo zonke izindawo zesifo esaziwayo, Ukuhlinzeka nge-immunotherapy, kanye no-Zytiga noma i-Xtandi.
I-High-Royal itholakala ukuthi kutholakala imithi engaphezu kwamahlanu. I-SBRT noma i-IMRT ene-metastases eminingi kaningi ayisebenzi. Uma lesi sifo singaqhubeki ngokushesha noma sibuhlungu, ukwelashwa kufanele kube nokunikezwa okulandelwa yiZytiga noma i-Xtandi. Isifo esibuhlungu noma esiphuthumayo kufanele siphathwe nge-Taxotere.
> Imithombo:
> D'amico, u-Anthony V., et al. "Isimiso esisekelwe emiphumeleni esenzelwe ukwelashwa kwe-adenocarcinoma yangakini ye-prostate." I Journal of urology 158.4 (1997): 1422-1426.
> Frank, uSteven J., et al. "Isigaba sesibili esilindelekile sokuhlolwa kwesifo se-prostate brachytherapy sokuhlala unomphela komdlavuza we-prostate wendawo: ukusebenza kahle, ubuthi, kanye nekhwalithi yemiphumela yokuphila." I-International Journal of Radiation Oncology * I-Biology * Physics (2017).
> Izibalo zomdlavuza we-Prostate 2017. https://www.cancer.net/cancer-types/prostate-cancer/statistics
> Sylvester, John E., et al. "Unyaka wezi-15 wezinto eziphilayo we-biochemical uphinde uqhubeke nokuphila okukhululekile emdlalweni we-Stage T1-T3 wesifo sofuba ngemuva kokuxhunyaniswa kwe-radiotherapy yangaphandle kanye ne-brachytherapy; isipiliyoni se-Seattle." I-International Journal of Radiation Oncology * Biology * Physics 67.1 (2007): 57-64.