Ukuhlolwa kwe-PSA, kanye ne-cholesterol nezinye izivivinyo, kuyisici esivamile sokuhlolwa kwegazi okwenzeka ngesikhathi sokuhlolwa komzimba konyaka komuntu. Kodwa yini okufanele uyenze uma i-PSA ingaphandle kwebanga elijwayelekile embikweni wakho webhu? Uma uhlola ikhophi yembiko ebhaliwe ebhaliwe, uveza ukuhlolwa kwakho, kungenzeka ukuthi uhlangabezane namanye amanothi achazayo (bheka ngezansi) okuvame ukuhlinzekwa kulo mbiko:
"Lokhu kuhlolwa kwe-PSA akufanele kuhunyushwe njengobufakazi obuphelele bokuba khona noma ukungabikho kwesifo esibuhlungu futhi akumele sisetshenziswe yedwa njengesivivinyo sokuhlola umdlavuza. Ukulungiswa kwemitholampilo kuyadingeka.
Ukuhlushwa kwe-PSA ephakanyisiwe kungabonisa kuphela ukuthi kukhona umdlavuza we-prostate kuze kube yi-biopsy eyenziwa. Ukuhlushwa kwe-PSA nakho kungaphakanyiswa kakhulu kwi-benign prostatic hyperplasia noma izimo zokuvuvukala ze-prostate. I-PSA ngokuvamile ayiphakanyisiwe emadodeni namadoda aphilile ane-carcinoma engeyona i-prostatic. "
I-Verbiage yalolu hlobo iphakamisa ukuthi isinyathelo esilandelayo sizoba yi-biopsy. Empeleni, kusho ukuthi i-biopsy cishe isiphetho esinqunyiwe. I-needle biopsy ye-prostate ukuhlola amadoda anePSA ephezulu ibe yindlela ejwayelekile yegolide iminyaka engama-30. Kuze kube yamuva, ukuthatha amasampula amaningi e-prostate ukuhlolwa okuncane kakhulu yindlela kuphela yokuthola umdlavuza we-prostate.
Inqubo Yengane Yengane Engahleliwe
Inqubo ye - biopsy engu-12 eyinhloko yenzalo ihlelwe kahle ngendlela ephumelelayo futhi ingenziwa ngumjozi we-urologist ehhovisi lakhe.
Le ndoda ihlezi eceleni kwayo imilenze yakhe idonsela esifubeni sayo. I-Novocain ijojowe nxazonke ze-prostate bese izinhlamvu eziyishumi nambili, ezinkulu-ezinezinaliti zikhishwa ngesibhamu se-biopsy esithwala entwasahlobo ngaphakathi kwe-rectum. Ama-antibiotic ajwayele ukuhlinzekwa ukuvimbela ukutheleleka.
Uma wenza ngobuchule, inqubo ye-biopsy ithatha amaminithi angu-10 kuya kwangu-20.
Ngemuva kwenqubo, amadoda avame ukuphuma egazini nasemasontweni amasonto ambalwa. Izinkinga zesikhashana nge-erections zingenzeka. Naphezu kwama-antibiotics, inani elincane lamadoda (cishe ngamaphesenti amabili) lizokhuliswa izifo ezinzima ngokwanele zokwelashwa. Ama-cores asuswe ku-prostate athathwa ukuze ahlolwe udokotela owaziwa ngokuthi i-pathologist. Imiphumela ngokuvamile iyatholakala ezinsukwini ezimbili ukuya kwezintathu.
Ukuhumusha Umbiko wePathology
Udokotela ohlola isampula se- biopsy , isazi sezempilo, kubika ukuthi ukutholakala noma ukungabikho komdlavuza kusuka emithonjeni isuswe ku-gland. Uma umdlavuza ukhona, udokotela wezokwelapha uphinde abike inani lomdlavuza (inani lamakhekhe anomdlavuza) kanye nebanga lomdlavuza. Ibanga lomdlavuza ungenye yezinto ezididayo kakhulu zomdlavuza wesibeletho.
Emuva ngawo-1960, udokotela wezifo odumile, uDkt. Donald Gleason, ubike ukuthi ukuziphatha komdlavuza wesibeletho esikhathini esizayo kungacaciswa ngamaphethini eselula abonwa ngaphansi kwe-microscope. Wakha uhlelo lokubamba kusukela ku-2 ukuya ku-10 olwakhulume ukuthi cishe kungaba njani umdlavuza ukusakazeka (ukuxubusha). Izingxenye zesistimu yakhe yokulinganisa i-Gleason iyaqhubeka isebenza kuze kube yilolu suku. Ezinye izici zesistimu ziye zashintsha ngokuhamba kwesikhathi.
Izinguquko ezinkulu kuye kwaba ukutholakala ukuthi izikolo ze-Gleason ezingu-6 noma ngaphansi azizona ezimbi. Nakuba lezi "amangqamuzana angavamile" eneminye yemidwebo yomdlavuza, izifundo zesayensi manje zithole ukuthi iGleason 6 noma ngaphansi ayihambisani nemiphumela. Amangqamuzana angavamile angalingani kufanele ahlukaniswe njengezicubu ezinobuthi, hhayi umdlavuza.
Imithi Yezokwelapha Ekushintsheni
Ngeshwa, ushintsho livela kancane emhlabeni wezokwelapha. Lapho wena noma othandekayo ethola ikhophi yombiko olusemthethweni wezokukhubazeka futhi ubone igama elithi adenocarcinoma, cishe uzothola lokhu kube yinto ephazamisayo kakhulu. Cishe abantu abayizigidi ezilodwa bawela biopsy njalo ngonyaka.
Kulaba bantu abayizigidi ezilodwa, cishe okungaphezu kuka-100 000 kuzo kuthiwa bane- Gleason 6 (noma ephansi) i-adenocarcinoma.
Imbonini yomdlavuza we-prostate ekugcineni iqala ukujwayela ekuqapheliseni ukuthi amagciwane e-grade 6 awona umdlavuza ngempela. Kodwa-ke, ngo-2015, cishe ingxenye eyodwa yamadoda atholakala ngeBanga 6 (ama-50,000 amadoda) abekwe ekuqapheni okuqapha ukubhekwa kunokuba abe nokuhlinzwa okusheshayo noma imisebe. Iqiniso lokuthi amadoda angama-50% ayenziwa ukwelashwa okukhulu, engozini ukuhlukunyezwa ngokocansi nokulahlekelwa ukulawulwa kwamagciwane (ukungabikho komzimba) ngesimo esingenabungozi, siphakamisa kakhulu ukuthi imboni yezokwelapha idinga ukuthuthukisa. Ukwelashwa okunjalo okunomthethelo kungabulungiswa kanjani ngalokho esikwaziyo manje mayelana nomdlavuza wesibeletho we-grade 6 noma ngaphansi?
Ikhansela LiyiZwi Lezinhlamvu Ezinine
Odokotela baqala ukushintsha ingqondo yabo, kodwa kuthatha isikhathi ukushintsha. Ingxenye yenkinga ukuthi umdlavuza uyinkulumo enobumba abane. Amalebula anamandla, ngisho noma engamanga. Isibonelo, igama elithi racist linikeza ukufana okuhle. Igama elithi "ngokobandlululo," kungakhathaliseki ukuthi leli gama lifanelekile noma lingelona iqiniso, linamathela njengeglue. Lapho abantu bezivikela ngokwengeziwe, i-guiltier ivela.
Enye into enamandla yokwehlisa ishintsho yilezi zindawo ezakhiwe ngomshini omkhulu womdlavuza we-prostate we-prostate eminyakeni engamashumi amane edlule. Kunzima ukuthi izazi ze-urologists zishintshe izindlela zazo futhi ziyeke ukuhlinzwa. Ukuchitha isikhathi ekamelweni lokusebenza kuyingxenye yobunikazi babo obumisiwe. Futhi empeleni, kuze kube ngu-10 eminyakeni edlule, kwakungekho ezinye izinketho. Ukwelashwa okuhlukumezayo kungase kube lula esikhathini lapho wonke umuntu ekholelwa ukuthi yonke umdlavuza wesifo sofuba wawusongela ukuphila. Ukwelashwa okukhulu kunesidingo somhlaba jikelele.
Ukungaqiniseki kokuqapha
Esinye isizathu sokuthi abesilisa abanomdlavuza wezinga eliphansi basalokhu belashwa ngokungadingekile ngokuhlinzwa ukuthi iziguli nodokotela ngokufanayo bayacabanga ukuthi kuyindlela ehlakaniphile. Ucwaningo lubonisa ukuthi i-biopsy engu-12 ayikwazi ukuthola umdlavuza wezinga eliphezulu (ibanga lesi-7 kuya ku-10) amaphesenti angu-25 esikhathi! Khumbula, ama-cores afakwa ku-prostate ngokungahleliwe , ngaphandle kokwazi indawo yesikhumba. Uma sicabanga ngalokhu okungaqondile, kukhona ukwesaba okunengqondo ukuthi umdlavuza wezinga eliphezulu ungase uhlale ungenakuthola ku-prostate. Ngezinye izikhathi amadoda akhetha ukwelashwa "Ukuze uvikeleke."
Labo abakhetha ukubhekwa okusebenzayo cishe banesifo se-prostate yabo yonke iminyaka embalwa. Kungenzeka bangakwazi, ukuthi odokotela babo bazama ukukhokhela ukungaqondile kwe-biopsy engahleliwe ngokuphindaphinda ngokuphindaphindiwe. Yize lokhu kungakhululekile futhi kuyingozi kakhulu, izifundo zesikhathi eside zibonisa ukuthi le ndlela iphephile. Iningi labesilisa abanesifo esiphezulu se-grade babhekene ne-biopsy yokuqala esitholwe yi-biopsy esilandelayo lapho umdlavuza usesikhathini esanele ngokwanele ukuthi usazophulukiswa.
Ukucabanga, Kuhloswe Kunokuba I-Biopsy Engahleliwe
Esikhundleni sokuhamba ngenqubo engahleliwe ye-biopsy engahleliwe, iziguli zingaya esikhungweni se-excellence sokuskena kwe-prostate nge-MRI ehlukahlukene. Ngezandla ezisebenzisekayo usebenzisa imishini ye-state-of-the-art, umdlavuza wezinga eliphezulu ungabhekwa ngokunemba okukhulu kunalokho okungazuzwa nge-biopsy eyi-12 ephakathi kokungahleliwe. Ngaphezu kwalokho, i-MRI ye-prostate ayiboni ukuthi kukhona umdlavuza weBanga 6 noma ngaphansi. Njengoba isifo esiphansi segciwane "siphuthelwa" yi-MRI yesicathulo, amadoda amaningi awashiywa ukwesatshiswa komdlavuza ongadingekile.
Kunezikhungo ezimbalwa zokucabanga ezizungezile ezweni lonke, cishe 50 kuya ku-100, ezenza i-prostate imaging ngendlela efanelekile. Izingxenye ezibalulekile zemiphumela ethembekile yizo:
- I-state-of-the-art, ama-scanner angu-3-Tesla Multi-Parametric MRI (mpMRI).
- Ochwepheshe be-MRI abaqeqeshwe kahle ngendlela yokwenza i-prostate imaging ngendlela efanele
- Odokotela abaqeqeshwe ngokucophelela ekuchazeni i-prostate imaging. Ukuthuthuka kwe-prostate imaging kwenzeka ngokushesha kangangokuthi ngisho nama-radiologists aqinisekiswe ngamabhodi ahlale engazi ukuthi ubuchwepheshe bamuva bungayifinyelela kuphi.
Amadoda ane-3T mpMRI imifanekiso engabonisi izilonda ezisolisayo angabheka i-biopsy ephelele futhi mhlawumbe ilandelwe ngemifanekiso eyengeziwe uma i-PSA yabo ihlala iphakanyisiwe. Uma i-lesion esolisayo itholakele, i-biopsy ehlosiwe esebenzisa amakhophi amathathu noma amane angabhekiswa ngokuqondile ekungajwayelekile.
Ukuhumusha umbiko we-Prostate MRI
Udokotela ofunda ukuskena ufingqa umbono wakhe jikelele wezinto ezitholakalayo, eziwela ezigabeni ezintathu eziyisisekelo:
- Akukho bufakazi bokuthi isifo esiphakeme (ngakho-ke, asikho isidingo sokuba ne-biopsy).
- I-lesion esolisayo itholakele. (I-biopsy ehlosiwe iyadingeka. Uma ngabe isifo esiphakeme sitholakala, ukuqhubeka okulandelayo kulandelwa ukwelulekwa mayelana nokwelashwa kuyadingeka).
- Indawo engalungile itholakala. (Kungakhathaliseki ukuthi i-biopsy ehlosiwe ingacatshangelwa noma enye, ukuqapha okuqhubekayo kanye nezinye izinyanga ezingu-6 kuya kwezi-12 ezinqatshelwe ukuskena kungacatshangelwa).
Nini kuziloyizi eziphilayo ezingezansi ze-Biopsy
Ukucabanga "kubona" zonke izinhlobo zezinto ngaphandle komdlavuza, kufaka phakathi izicubu ezincane, izindawo zokuvuvukala okusebenzayo (prostatitis), kanye nezindawo ezine-nodular ze- prostatic hypertrophy (BPH). Izilonda ezikhathazeka kakhulu yizo ezinkulu, ezisezindaweni zomgwaqo we-prostate, zikhukhumeza i-capsule, noma zihlotshaniswa nokwanda kwegazi noma ukusabalalisa. Isilonda esiyinkimbinkimbi singadinga i-biopsy uma izilinganiso ezilandelayo zokulandelela zibonisa ukukhuliswa okuqhubekayo. Isinqumo sokuthi ingabe i-biopsy i-lesion engaqondakali ngokushesha noma iqhubeke nokuqapha nge scan scan ngezikhathi ezithile kufanele yenziwe ngokuxoxa phakathi kwesiguli nodokotela wezokwelapha owaziyo lobu buchwepheshe obusha.
Misa i-PSA Screening Yonke?
Ngo-2011, ngenxa yezikhathazo mayelana nokuxilongwa ngokweqile kusuka ekuhlolweni kwe-PSA kanye ne-biopsy okungahleliwe okuholela emiphumeleni emibi kakhulu emitholampilo engadingekile, i-US Preventative Services Task Force iphakanyiswe ngokumelene nokuhlola ukuhlolwa kwe-PSA . Ucwaningo lubonisa ukuthi odokotela abaningi baseziqhingini bathatha lezi zincomo ngenhliziyo futhi bayeka ukwenza ukuhlolwa ngokugcwele. Kodwa i-Task Force ayitholakali iphuzu. Ukuhlolwa kwe-PSA akuyona inkinga. Inkinga isheshayo kwi-biopsy okungahleliwe noma kunini lapho kuphakama i-PSA. Indlela yokucophelela, eqondile eqala nge-prostate imaging futhi ilandela i-biopsy ehlosiwe uma kungabonakali okungavamile kungaqeda inkinga yokwelapha ngokweqile.
Imicabango Yokugcina
Izwe lezezokwelapha lishintsha kancane kancane ukuthi indlela eyi-12-core random isalfo biopsy iholela ekuxilongweni okungadingekile kwe-Cancer, Gleason-grade 6. Unyaka ngamunye e-United States amadoda angama-100 000 atholakala enalezi "khansa" ezingenabungozi. Ngeshwa, abaningi babo badinga imisebe noma ukuhlinzeka ngokungadingekile noma kunjalo. Isinyathelo sokuqala sokuthola ukunakekelwa kangcono kwabesilisa abahlolwayo nge-PSA kufanele kube ukusetshenziselwa kabanzi kokusakazwa kwe-state-of-the-art, hhayi ukusheshisa ukwenza i-biopsy engahleliwe.
> Imithombo:
> Eggener S, et al. I-Journal of Urology Vol. 185, P. 869, Mashi 2011.
> Klotz L, et al. I-Journal of Clinical Oncology Vol. 28, P. 126, Januwari 2010.
> Sakr W, et al. I-Journal of Urology Vol. 150, P. 379, 1993.
> Thompson I, et al. I-New England Journal of Medicine Vol. 349, P. 215, July 2003.
> I-US Preventative Task Force. I-prostate Cancer: Ukuhlolwa. Meyi 2012.
> Wilt T, et al. I-New England Journal of Medicine Vol. 367, P. 203, July 2012.