Njengoba kunemikhakha emithathu engozini yokuthola umdlavuza we-prostate osanda kutholakele- ukwelashwa okuphansi, okuphakathi nendawo ephakeme kakhulu kuyahlukahluka. Ngokuvamile, indlela yethu yokugqugquzela ukubhekwa kweziguli eziphansi kakhulu, ukufaka imbewu kubantu abanezifo ezingenasisemkhatsini, kanye nokuhlwanyela imbewu kanye nokwelashwa okwengeziwe kubantu besigaba esingozi kakhulu . Lezi zinqumo zavela ngokucwaninga okuqhathanisa imiphumela phakathi kwezokwelapha ezahlukene.
Ukuhlinzwa noma i-Beam Radiation?
Nokho, ochwepheshe abaningi abavumelani. Ngokwesiko, izinhlobo ezimbili kuphela zokhetho zokwelapha, ukuhlinza noma ukushisa imisebe, zihlinzekwa odokotela abahlinzayo nabadokotela bama-ray, odokotela ngokuvamile abaphatha abantu abane-cancer yomzimba. Imithi yokuqapha noma i-radioactive, eyaziwa nangokuthi i-brachytherapy, ivame ukushiywa ngaphandle kwengxoxo.
Sekuyiminyaka, kugxile ekuqhutshweni kwempikiswano phakathi kokuhlinzwa kanye nemisebe, umbuzo othi, "Ingabe ukhetho olulodwa lungcono?" Futhi ngokuthi "ngcono", sisho ukuthi: yikuphi ukwelashwa okunezinga eliphezulu kakhulu lokuphulukisa kanye nomthelela ophansi kakhulu ekugumbeni kwamanzi umsebenzi?
Sekuyisikhathi eside kusolwa ukuthi ukuhlinza nokushiswa kwemisebe kunemiphumela efanayo, kodwa ukufaniswa kwezesayensi kwekhwalithi ukucacisa ukuthi umuntu uhle kangcono kunomunye ongenakho. Ngakho-ke, iziguli nodokotela ngokufanayo baye bathembela ekucabangeni ngokomzwelo nangomuntu siqu mayelana nokwaziswa okunengqondo, okunengqondo.
Kodwa-ke, amadoda afuna izimpendulo manje abusisiwe ngokuthuthukiswa okusha okuphawulekayo-ukushicilelwa kwesilingo esihlokweni somtholampilo, ngokulinganisa ukuhlinzwa, ukushiswa kwemisebe, nokubhekwa okusebenzayo.
Ukuhlolwa okungahleliwe kuyingqayizivele ngoba baphendula umbuzo othize ngokuphumelelayo, ukuphoqelela ukuqedwa kwezinkinga, inkinga egcwele ngokuvivinya okuphindaphindiwe (ngaphezu kwamaphesenti angamashumi ayisishiyagalolunye nesishiyagalolunye ovivinyo okuqhathaniswa nokuhlinzwa kanye nemisebe iyabuyiselwa).
Isizathu sokuthi kunamalingo ambalwa okuhlolwa ukuthi abacwaningi kumele bathole iziguli ezizimisele ukwelashwa ngezikhathi ngezikhathi. Ekulinganisweni okukhulunywe ngezansi, la madoda kufanele "athole imifino" ngokomfanekiso ukuze abone ukuthi ubani ozohlinzwa, imisebe noma ukubhekwa ngenqubo ebizwa ngokuthi "i-randomization".
Ucwaningo oluningi lokuphindaphindiwe lukhona kakade, ukuzama ukuqhathanisa imiphumela yemisebe nokuhlinzwa. Nokho, zingcoliswa yizici eziningi eziphazamisayo, isibonelo esisodwa sokungalingani kweziguli. Ngokuvamile, amadoda amancane anikezwe ukuhlinzwa futhi amadoda amadala aphathwa nge-radiation.
Ukuqhathaniswa okunjengalokhu kungalungile ngoba kuyaziwa ukuthi amadoda amancane anemiphumela engcono kungakhathaliseki ukuthi yiluphi uhlobo lwezokwelapha olwenziwa. Kuze kube manje, kusukela kuphela "idatha yesayense" eye yinto yedatha ephindaphindiwe etholakala emaqenjini angalingani, odokotela baye bakhululekile ukukhetha noma yikuphi ukutadisha okuphindaphindiwe kusekela ukuxhaswa kwabo siqu ukuvikela isikhundla sokuthi ukwelashwa okukodwa kudlula omunye.
Ukuhlola okusebenzayo
Ngakho kungani kungakaze kube khona noma iyiphi idatha okumele ihlolwe ukuqhathaniswa nokuhlinzwa, ukushiswa kwemisebe, nokubhekwa okusebenzayo? Okokuqala, ukuhlolwa okunjalo kuyabiza kakhulu. Amakhulu emadodeni adinga ukuqapha iminyaka engaphezu kwengu-10.
Okwesibili, kunzima ukuthola amadoda azimisele ukudweba imigqa yokukhetha ukwelashwa. Okwesithathu, njengoba ukuhlolwa kuthatha isikhathi eside ukuvuthwa, ukuklanywa kwesilingo esinjalo kudinga ubuhlakani bokubonisana ukuqinisekisa ukuthi umbuzo ophendulwa yicala uzobe usufanele eminyakeni engu-15 esikhathini esizayo.
Njengoba kunzima njengokungahleliwe, izivivinyo ezizobhekana nazo kufanele zixhaswe futhi zenze, zidinga kakhulu. Ukungabi khona kwezilingo ezingahle kwenzeke njalo kuholela ekuphikisana nokungaziphathi kahle. Ngaphandle kolwazi olucacile, ukhetho lwezokwelapha luphela luqhutshwa ngokucatshangelwa ngokwezezimali -ukwelashwa okukhokha okungcono kakhulu kuyinto ethandwa kakhulu.
Ngakho-ke ukushicilelwa kwamuva kwezifundo eziningana ezihleliwe ngokuqondile ngokuqhathanisa imiphumela yokwelapha yokuhlinzwa, ukukhanya kwemisebe nokubhekwa okusebenzayo kuyiqiniso ngempela. Lezi yizenzakalo eziphawulekayo ezenza sikwazi ukugcina iqiniso elingezansi.
Ngo-September 2016, i-New England Journal of Medicine yanyathelisa isihloko esithi "Imiphumela Yonyaka Wezinyanga Ezi-10 Ngemva kokuqapha, Ukuhlinzwa, noma i-Radiotherapy ye-Localized Prostate Cancer". Kulesi sivivinyo, amadoda angu-1650 ahanjiswe ngokungahleliwe ukubhekwa, ukuhlinzwa noma ukushiswa kwemisebe, futhi kulandela iminyaka eyishumi. Uhlobo lwamadoda abambe iqhaza kulolu cwaningo lwaluyinto evamile yendoda ejwayelekile etholakala ukuthi isifo sesifo sokuqala ngesifo sokuhlolwa kwe-PSA . Ubudala babo bengu-62. I-PSA ephakathi yayingu-4.8.
Amadoda amathathu nesine ala madoda ayengenakulinganiswa ekuhlolweni kwawo kwe-digital prostate kanti enye yesine yayinezinkinga ezingavamile. Ngaphansi kancane kwamatshumi amathathu nantathu wamadoda kwakuyi score ye-Gleason ayisithupha. Omunye wabayisihlanu wamadoda kwakungu-Gleason score 7 kanti indoda eyodwa kwabangu-40 inomdlalo ophezulu weGleason, ophakathi kuka-8 kuya ku-10.
Ngemuva kokuvuma ukubamba iqhaza kulolu cwaningo , amadoda abelwe ukuhlinzekwa ngokushesha, ama-radiation ngokushesha noma ukubhekwa okusebenzayo. Labo abanikezwe ukubhekwa babebhekene nesifo sabo njalo ukuze kutholakale ukwelashwa uma kudingeka.
Esikhathini esilandelayo seminyaka eyi-10 yokubheka, cishe isigamu samadoda ekubhekiseni satholwa ukwelashwa okuphuzile ngokuhlinzwa noma imisebe. Ngokuthakazelisayo, iningi lamadoda ekubhekeni okhethwe ukwelashwa wenza kanjalo ngezizathu ezingokomzwelo kunengqondo. Ngamanye amazwi, banquma ukuthi babe nokwelashwa nakuba ezimweni eziningi kungekho bufakazi bokuthi isifo sabo sasiqhubeka.
Wonke amaqembu amathathu okwelashwa ahlolwe ngenxa yokufa komdlavuza we-prostate. Ngemuva kweminyaka eyishumi, kwabulawa abantu abangu-17 abahlobene nomdlavuza wesifo sofuba, ngokufanayo kuwo wonke amaqembu amathathu-isilinganiso samaphesenti angu-1 eqenjini ngalinye-kanti abantu abangu-169 ababulawa kwezinye izimbangela ngaphandle komdlavuza we-prostate. Abayisishiyagalolunye kwabayisishiyagalolunye babulawa yiziguli ezinesilinganiso sokuqala esingu-7 noma ngaphezulu. Ukufa kwabikwa ngamadoda angu-8 no-Gleason 6 kodwa kusukela kulolu cwaningo laklanyelwe eminyakeni eminingi edlule, ukuxilongwa kuxhomeke ku-biopsy okungahleliwe kunokuba i-imaging ene-MRI ehlukahlukene. Ucwaningo oluningi lubonise ngokucacile ukuthi i-biopsy engahleliwe ilahlekelwa izifo eziphezulu kakhulu kaningi kuneMRI ehlukahlukene.
Okubaluleke kunazo zonke ukususa kulolu cwaningo kwakuwukuthi phakathi kwamaqembu amathathu, kwakungekho umehluko kumazinga okufa eminyakeni engaphezu kwengu-10.
Thatha isifundo
Ngakho-ke ngokusho kwaleli datha elisha futhi elinokwethenjelwa, izinga lokufa kwabantu abaneminyaka eyishumi lihlala lilingana ngokufanayo noma ngabe isiguli sikhetha ukuhlinzwa, ukushiswa kwemisebe noma ukubhekwa okusebenzayo. Kuthiwani ngekhwalithi yokuphila? Isihloko somngane esichazwe ngenhla siphinde sanyatheliswa eNew England Journal ngosuku olufanayo, ukubika imiphumela yekhwalithi yempilo ngayinye yezokwelapha ezintathu ezihlobene nomsebenzi wezocansi nokuvuthwa. Ngokuqondene nomsebenzi wezocansi, izingxenye ezimbili kwezintathu zamadoda esifundweni zaziyizandla ngaphambi kokuthola ukwelashwa. Ngemuva konyaka owodwa, amaphesenti wamadoda agcina i-potency, okungukuthi, abe nama-erections "aqine ngokwanele ukulala" ayefana nalokhu:
- Ukuqapha okusebenzayo = amaphesenti angu-49
- Imisebe yangaphandle yesibhamu = amaphesenti angu-38
- I-prostatectomy enkulu kakhulu = amaphesenti angu-15
Ngonyaka owodwa emva kokuqala ukutadisha la madoda aphinde axoxwe mayelana nokuba khona noma ukungabikho kokuvuza kwamanzi okudinga ukusetshenziswa kwamapayipi. Amaphesenti owodwa ala madoda abika ukusetshenziswa kwamapayipi ngaphambi kokuqala kocwaningo. Izinkinga ngenxa yokucwilisa isikhathi esiningi kakhulu ebusuku zifana nazo zonke amaqembu amathathu futhi zahlala ngemuva kokunakekelwa. Ngemuva konyaka owodwa, iphesenti lalabo abasebenzisa amapayipi kwaba:
- Ukuqapha okusebenzayo = amaphesenti angu-4
- Imisebe yangaphandle yesibhamu = amaphesenti angu-4
- I-prostatectomy enkulu kakhulu = amaphesenti angu-26
Ukuhlanganisa imiphumela yezilinganiso ezimbili ezingenhla, singakwazi manje ukuphendula umbuzo wukuphi ukwelashwa okunezinga eliphezulu kakhulu lokuphulukiswa nemiphumela emibi? Ukuhlinzwa, ukushiswa kwemisebe, nokuhlola okusebenzayo konke kunomphumela ofanayo wokuphila, kodwa ukubhekwa okusebenzayo kuphuma ngenani lemiphumela emincane .
Enye indlela yokuphawula mayelana nensimbi esebenzayo yokubhekwa kulesi sivivinyo ngenhla kwakuwukuthi ukukhula komdlavuza, okungukuthi isifo semetastasis sasiyinto encane emadodeni ayehlinzwa noma ama-radiation uma kuqhathaniswa namadoda ayebhekene nokubhekwa-13 ngokumelene namadoda angama-33 ngokulandelana. Ngakho-ke, uma singayinaki izinga lempilo ngokugcwele futhi sichaza "amazinga okuphulukisa" njenge "inkululeko yokukhula komdlavuza," kunokuba "ukusinda", iqembu lokubhekwa libi kakhulu kunezokuhlinza noma ama-radiation, ngaphandle kokuhluka phakathi kokuhlinzwa nokushisa imisebe .
Noma kunjalo, njengoba kuphawuliwe ngenhla, inkinga eyodwa ngokuhumusha izilingo ezakhiwe eminyakeni engu-15 kuya kwengu-20 eyedlule ukuthi zithembele ebuchwepheni obungase buphelelwe yisikhathi. Amazinga okuguqulwa kokuhlinzwa kanye nemisebe yashintsha kakhulu, uma ikhona, ngaphezu kweminyaka engu-15 edlule.
Kodwa-ke, ubuchwepheshe bokuqapha kwabesilisa ekubhekeni okusebenzayo buye kwathuthukiswa kakhulu ngokufika kwe-imaging enembile nge -MRI ehlukahlukene. Ukucabanga kwangaleso sikhathi kuncipha kakhulu ingozi yokugula okungenakubalwa okungenakubalwa, inkinga evamile ehambisana nokuqapha okuthembela ekuhlolweni kwezinto eziphilayo ezingahleliwe. Lezi zinsuku, ubuchwepheshe be-MRI obukhulu be-MRI bukwazi ukuqinisekisa ukuhlukaniswa kwemikhakha enembile ukunciphisa ingozi yokuqhubeka komdlavuza emadodeni afisa ukuphishekela ukuqapha okusebenzayo.
Izimpande Zembewu Yomsakazo
Okunye ukuphumelela kwezobuchwepheshe bekulokhu kuqaphela ukuthi ukufakelwa kwezinhlanyelo ezinomsakazo kubangelwa amazinga aphezulu okuphulukiswa kunemisebe engavamile. Kwesinye isifundo somlando esanda kushicilelwa esanda kusanda kuqhathaniswa nemiphumela yemisebe yodwa ngokumelene nemisebe kanye nokufakelwa kwembewu, ukuguqulwa kwamazinga okuhlonywa kwezimbewu kubonakala sengathi kuphakeme kakhulu. Bonke amadoda kulolu cwaningo babe nezinhlobo ezingekho emthethweni zengozi ephakathi noma engozini enkulu yomdlavuza wesifo sofuba.
Ngemuva kweminyaka emihlanu ukwelashwa, izinga lokuphulukiswa kwemisebe yedwa lalingamaphesenti angu-84 kanti izinga lokuphulukiswa kwemisebe yelinye imbewu laliyizingamaphesenti angu-96. Ngemuva kweminyaka eyisishiyagalolunye, inzuzo yezinhlamvu yayigxile nakakhulu. Ngaphandle kwembewu, izinga lokuphulukisa lalingamaphesenti angama-70 kuphela kanti amaphesenti angama-95 wamadoda athola ukuhlanganiswa kwemisebe kanye nembewu yahlala yelashwa.
Ngokusobala, izimila zembewu zikhuthaza kakhulu ukuphulukisa amazinga. Kunesilingo esisodwa esisha esibheka ukuthi izimpande zenzelwa kanjani zona zonke, ngaphandle kwanoma yikuphi ukushisa kwemisebe. Leli cwaningo lafunda amadoda angama-558 angafani phakathi kwemisakazo kanye nembewu ehambisana nezinhlobo zodwa. Isilinganiso seGleason esiphezulu saba ngu-7 kanti i-PSA yayingaphansi kwe-10. Ngemuva kweminyaka emihlanu ukwelashwa, izinga lokuphulukisa lalifanayo emaqenjini angu-85 no-86 ngamaphesenti ngokulandelana.
Imiphumela emibi yesikhathi eside, kodwa, yayingaphansi imbewu kuphela, amaphesenti angu-7 aphakathi kwamaphesenti angu-12 ala madoda athola inhlanganisela. Leli cala libonisa ukuthi imishanguzo eyongezwe kumbewu ayidingekile futhi inobuthi kunemifucumfucu yembewu enikezwe yona ngokwayo.
Ukuhumusha Idatha
Yini okufanele wena njengesiguli ususe kule datha? Uma sicabanga ngezigaba ezintathu zesifo somdlavuza we-prostate, kulabo abathinta iphrofayili, ukubhekwa okusebenzayo kubhekene nesinyathelo sokuqala esingcono kakhulu samadoda anezifo eziphansi kakhulu. Inemiphumela emibi kakhulu kanye nomphumela ofanayo wokufa njengalabo abakhetha ukuhlinzwa noma ukushisa imisebe. Manje njengoba sinendlela enembile yokuskena la madoda esifo sezinga eliphezulu nge-MRI multi-parametric, ukubhekwa okusebenzayo kuba inketho ekhangayo nakakhulu.
Amadoda anomdlavuza we-prostate oyingozi futhi ophezulu kufanele aphathwe ngokufaka imbewu. Isidingo sokwenyuka kwemisebe yezingxenye ezihambisanayo kufanele sibuzwe ngokungathí sina. Manje ngemininingwane ethembekile ukusekela lezi zindlela ezincane ezingavumelani, kokubili ukungaqiniseki nokucindezela okuzungezile ukhetho lwezokwelapha kunganciphisa kakhulu.
> Imithombo:
> I-American Cancer Society. Izindleko zokusinda ze-Cancer Prostate.
> Cooperberg MR. Ukuqapha okusebenza isikhathi eside kwe-cancer yomzimba: izimpendulo nemibuzo. J Clin Oncol. 2015; 33 (3): 238-40.
> Hamdy FC, uDonovan JL, uLane JA, et al. Imiphumela Eminyaka Eyishumi Ngemva kokuqapha, ukuhlinzwa, noma i-Radiotherapy ye-Canned Prostate Cancer. N Engl J Med. 2016.