Ukuhlola Okusebenzayo, Ukuhlinzwa, noma Ukushisa? Okushiwo yizifundo
Ngenxa yokungabi khona kwezinhlelo eziqhathaniswa kahle, ukhetho lwezokwelapha lomdlavuza we-prostate lube luphikisana kakhulu. Kodwa-ke, ngo-Okthoba 2016, izihloko ezimbili eziphawulekayo ezanyatheliswa eNew England Journal of Medicine ezibika ngeminyaka eyishumi ezivela ezivolontiya ezingu-1,643 ezizivumile ezazinikezwa ngokungahleliwe (ngokuhambisana "nemidwebo yokudweba") ekwelapheni ngokuhlinzwa, ukushiswa kwemisebe noma ukusebenza ukubhekwa.
Ucwaningo lokuqala luqhathanise imiphumela yeminyaka engu-10, kanti isifundo sesibili, somngane, sasebenzisa imibuzo yokuqhathanisa umphumela wekhwalithi yokuphila. Okokuqala, sizoxoxa ngombuzo osinda. Bese sizoxoxa ngekhwalithi yokuphila.
Ukubaluleka kokuKwakha isifundo
Ukuthola amavolontiya ukuba bahlanganyele ekwelashweni okwenziwe ngokungahleliwe, kunokuba bakhethe ukwelashwa ngokwabo, kunzima ukufeza. Akumangazi ukuthi lokhu kuwukuphela kokucwaninga okushicilelwe kwalolu hlobo. Nanobe kunjalo, ukuhlelwa kwesikhashana kubalulekile ukuze kuqinisekiswe ukuthi iziguli eziseqenjini ngalinye lazo ezintathu ziphilile futhi zinomdlavuza owodwa ofanayo. Ngaphandle kwesiqinisekiso sobuhle phakathi kwamaqembu, imiphumela yocwaningo ngeke ibe yithembekile.
Ukuziqhathanisa NeSifundo
Ukubaluleka okuyinhloko kokutadisha okungahleliwe ukuthi iziguli ezisanda kutholakala umdlavuza zingathola ulwazi olunembile mayelana nendlela lezokwelapha ezintathu ezithinta kakhulu eziqhathaniswa ngayo.
Kodwa-ke, ukwenza ukufaniswa okunembile, iphrofayli yesiguli kumele ifane neziguli ezahlanganyela kulolu cwaningo. Ngakho-ke, ake sibukeze iphrofayli yabathintekayo bokutadisha. Iminyaka yabo isukela kuma-50 kuya ku-69, abaneminyaka yobudala eyi-62. I-PSA ephakathi yayingu-4.6. Ngesine kweyodwa yamadoda, udokotela wayengase abe nomuzwa wokuthi u-prostate unomunwe wakhe.
Abesilisa abayisishiyagalolunye kwabayishumi babe namazinga e-PSA ngaphansi kweshumi (nakuba kwakukhona iziguli ezimbalwa ezinezinga le-PSA phakathi kuka-10 no-20). Abesithathu kwabesilisa abane-Gleason 3 + 3 = 6., eyodwa-yesihlanu yayineGleason 7, kanti omunye kwala madoda angamatshumi amahlanu abe neGleason izikolo ezingu-8 kuya kwezingu-10.
Ukuqapha Ngokuhlola Okusebenzayo
Ukuqapha noma yini okuthiwa "umdlavuza" uhlala kahle neziguli nodokotela ngokufanayo. Umqondo omusha omuhle futhi indlela yokuqhubeka ishintsha. Indlela yokuqapha kulolu cwaningo ithembele cishe ku- PSA kuphela . Ukusetshenziswa kwe-biopsies yokulandelela noma ukucabanga nge-MRI multiparametric akukhuthazwa okungavamile ngamazinga anamuhla. Ngaphezulu kweminyaka engu-10 yocwaningo, cishe isigamu samadoda esiqenjini sokubhekwa sasihlinzwa noma imisebe engavamile. Ifilosofi eyisisekelo ngemuva kokuqapha okusebenzayo ukubuka amadoda eduze, futhi uma umdlavuza ukhula, sebenzisa ukwelapha ukwelashwa ngaphambi kokuba umdlavuza usakazeke.
Impact of Treatment on Survival
Umklamo oyinhloko wesifundo kwakuwukuba uphendule umbuzo owodwa- ukusinda. Lapho amadoda eqala ukuzwa ukuthi unomdlavuza, iningi liyadliwa ngemicabango mayelana nendlela yokugwema ukufa kwangaphambili. Uma ukusinda kubaluleke kakhulu, lolu cwaningo luyabika ngokucacile ukuthi indlela yokwelashwa ayenzi umehluko .
Kuwo wonke amaqembu amathathu, umphumela wawufana. Amaphesenti angu-1 kuphela wamadoda (angama-17 amadoda) abulawa umdlavuza wesibeletho phakathi neminyaka eyishumi yokuqala. Lesi sibalo siphansi nakakhulu uma sicabangela ukuthi ngabe umphumela wawuyoba yini uma amadoda aneGleason 7 kanye / noma i-nodule enamahlombe ayengabandakanyi esifundweni. Eminyakeni eyishumi yokuqala, kwabulawa abantu abayisithupha nje kuphela emadodeni aphethe iGleason 6 kanye nokuhlolwa okujwayelekile kwemigqa (la madoda ayisithupha asatshalaliswa ngokufanayo kuwo wonke amaqembu amathathu). Umthelela wokwelapha ekufeni, okungenani phakathi neminyaka eyishumi yokuqala, kubonakala kungabalulekile.
Kuthiwani Ngama-metastases?
Kodwa kuthiwani emva kweminyaka eyishumi?
Lokhu akuyona umbuzo ophezulu ophezulu kakhulu emadodeni asunduza angu-70; amadoda angama-80 azoba namathuba okufa ngenxa yezimbangela ezingafani. Kodwa ngokuqinisekile umbuzo ofanele kubantu abaseminyakeni yawo-50. Ucwaningo lubika ingozi ephakeme kakhulu yokuthuthukisa imishanguzo eqenjini lamadoda ayebhekene nokubhekwa uma kuqhathaniswa nokuhlinzwa okusheshayo noma imisebe. Ngokuqondile, amadoda angu-29 kuphela, abayishumi nambili abahlinzwa futhi abangu-16 ababenemisebe, bahlala nemithamo emva kweminyaka eyishumi; kanti amadoda angu-33 ekubhekeni ayebhekene nezidakamizwa . Lokhu kubala ingozi engamaphesenti angu-3 ephakeme yemitha yokushisa ngokubhekwa ngokuqhathaniswa nokuhlinzwa okusheshayo noma imisebe. Akuyona umehluko omkhulu kakhulu, kodwa ngokuqinisekile kufanelekile uma ungomunye wabantu abangenangqondo emaphesenti angu-3.
Impact of Metastases on Ukusinda
Njengoba okungenani ngamaphesenti angu-50 amadoda ahlakulela i-metastases ekugcineni azobulawa umdlavuza wesi-prostate, kubonakala, ngokusho kwalolu cwaningo, ukuthi amadoda aphethwe ngokusebenza ngokucophelela azoba nesilinganiso sokushona okungenani (mhlawumbe 1 kuya ku-2 amaphesenti aphezulu) livela eminyakeni engu-10 ukuya kwengu-20 emva kokuxilongwa, uma kuqhathaniswa namadoda athola ukuhlinzwa okusheshayo noma imisebe. Noma kunjalo, leli qiniso kufanele lithathwe ngokusanhlamvu okusanhlamvu olukhulu, becabanga ukuthi amasu okubhekwa asetshenziselwa ayengeneli ngamazinga anamuhla. Njengoba kuphawuliwe ngenhla, la madoda ayebhekwa kuphela nge-PSA. Babengenaso ukuskena okuvamile nge- MRI multiparametric , futhi kwakungekho ukuhlola okungahleliwe kwe-biopsies okwenziwe ngezikhathi ezihleliwe. Lezi ziguli zishiywe kakhulu kakhulu ukuzizivikela. Uma sicabanga ngalezinga elimangalisa lokunganaki, inani le-metastases elanda ngamaphesenti amathathu kuphela empeleni libonakala liphansi.
I-Technology Surveillance iye yathuthukiswa ngokuphawulekayo
Kukhona esinye isizathu esicindezelayo sokukholelwa ukuthi izinga eliphakeme le-metastasis elibikiwe kulolu cwaningo liveza ukuthi ingozi yokusebenza ngokucophelela. Iphrofayela yamadoda avunyelwe kulolu cwaningo ayilona uhlobo lwamadoda avame ukunconywa ukubhekwa okusebenzayo. Ingxenye yesine yamadoda kulesi sifundo inezinhlamvu ezingu-7 ze-Gleason noma ezingaphezulu, i-nodule ene-palpable etholakalayo ekuhlolweni kwe-digital rectal ye-prostate yabo, noma kokubili. Lolu hlobo olunamandla kakhulu lwephrofayela yomdlavuza kunalokho ngokuvamile kuvunyelwe ukuqapha.
Ukuthuthukiswa Kwezetheknoloji Nezokwelapha Noma Ukushiswa Kwemitha?
Ngaphambi kokuba sishiye ingxoxiswano yethu yokuphila futhi siqhubekele ekuxoxweni ngekhwalithi yokuphila, nginolwazi olwengeziwe lokunikela. Ngigxeke indlela yokutadisha ngokuthembela ekuqapheni kwe-PSA yedwa njengoba enganele. Kodwa kuthiwani ngamasu okuhlinza noma ukushiswa kwemisebe? Ngabe singalindela izinga lokuphulukisa eliphakeme ngokusebenzisa ubuchwepheshe be-2016 uma kuqhathaniswa nalokho amadoda okulesi sifundo athola? Impendulo emfushane ayikho. Nakuba ukuhlolwa kokuhlinzwa kwe-robotic kubika ngokushesha ukuphulukiswa, amazinga okuphulukisa kanye namazinga okubuyiselwa kocansi nokucubungula awuthuthukisiwe. Ngokuqondene nomswakama wangaphandle we-radium, amazinga okuphulukisa nemiphumela emibi nge-IMRT yanamuhla ayisezingeni elifanayo.
Ikhwalithi Yezindaba Zokuphila Uma Ukusinda Kungokufanayo
Ukuphishekela ukubhekwa okusebenzayo kunengqondo uma kuhunyushwa ngezinga lokuphila. Isizathu esisodwa sokuyeka ukwelapha ukwelashwa ukukhathazeka okusekelwe kahle ukuthi umsebenzi ovamile wobulili kanye nomchamo uzobe unzima kakhulu. Uma ukwelashwa kungenayo imiphumela emibi, wonke umuntu angaba nokwelapha; amadoda angaqhubeka nokuphila kwawo futhi akhohlwe ngokuqapha ngaphandle kwe-PSA check periodic. Kodwa-ke, ake sibhekane nezinkinga ezihlobene nokwelashwa ezivame kakhulu, ingozi yokungabi namandla nokungaziphathi kahle.
Imibuzo ngaphambi nangemva kokulashwa
Esifundweni somngane ukuhlola izinga lokuphila, bonke abahlanganyeli babuzwa ngomsebenzi wabo wezocansi nokulawulwa kwamanzi ngaphambi kokunakekelwa, izinyanga ezingu-6 nezinyanga ezingu-12 ngemuva kokwelashwa, futhi njalo ngemva kwalokho. Kulesi siqhathaniso, ukuhlinzwa kwakubonakala kalula njengendlela ebi kunazo zonke kusukela embonweni wokuphila. Ngaphambi kokunakekelwa, amaphesenti angu-1 kuphela amadoda ayene-incontinence ye-urinary futhi ayedinga amapayipi angenayo. Kodwa lokho kwanda ngamaphesenti angu-46 emva kwezinyanga eziyisithupha ngemuva kokuhlinzwa futhi kancane kancane kwaphuthuka kuya kuma-17 amaphesenti ayisithupha kamuva. Eminyakeni eyisithupha emva kwemisebe ngakolunye uhlangothi, amaphesenti angu-4 kuphela ala madoda ayedinga i-pad. Amaphesenti ayisishiyagalombili emadodeni okubhekwa afuna i-pad (khumbula ukuthi cishe amadoda angamaphesenti angu-50 ekubhekeni okusebenzayo athola ukuhlinzwa okuphuzile noma imisebe).
Impact of Treatment on Umsebenzi Wezocansi
Ngicabanga ukuthi indlela ecacile kakhulu yokukhulumisana okufundwayo okufundwayo emsebenzini womsebenzi wezocansi / umthelela ukukunikeza ukucaphuna okuqondile kusuka ocwaningweni:
"Ekuqaleni, amadoda angamaphesenti angama-67 abike ukuthi ama-erections aqinile ngokwanele ekuziphatheni komzimba kodwa ngezinyanga ezingu-6 ezawela ezingamaphesenti angu-52 eqenjini eliqaphayo, emaqenjini angu-22 eqenjini lama-radiation nakumaqembu angu-12 eqenjini lokuhlinza. Umsebenzi we-Erectile wagcina ubi kakhulu eqenjini lokuhlinzeka ngaso sonke isikhathi amaphuzu, kanti nakuba kwakukhona ukubuyisela kwamaphesenti angu-21 eminyakeni emithathu, leli nani liye laphinde laphindela kuma-17 amaphesenti eminyakeni engu-6. Isilinganiso seminyaka engu-6 eqenjini lama-radiation laliyizingamaphesenti angu-27. Isilinganiso esigabeni sokuqapha esisebenzayo sasingamaphesenti angu-41 eminyakeni emi-3 namaphesenti angu-30 ngonyaka 6. "
Nakuba kuzoba nokunciphisa okungenakugwema emsebenzini wokusebenza ngokocansi ngokuhamba kwesikhathi kula madoda asebekhulile, imiphumela isabonisa ukuthi ukuhlinzeka kunomthelela omubi kakhulu kunama-radiation noma ukubhekwa okusebenzayo. Njengoba kuboniswe kulolu cwaningo, ingxenye yesithathu yamadoda kule nkathi yobudala isivele ingenamandla ngaphambi kokwelashwa. Njengoba amadoda angenamandla angenakukwazi ukwenza amandla angaphezu kwemisebe, kanti neminye imiphumela emibi yayingavamile, kubonakala kunesisusa esincane sokugwema imisebe engxenyeni yamadoda enesimo sokungapheli amandla.
Iziphetho ezivela kulezi zifundo ezimbili zomlando
Okokuqala, izinga lokusinda ngokubhekwa okusebenzayo lilingana nokuhlinzekwa ngokushesha noma imisebe kuze kube yiminyaka eyi-10. Ukuqinisekisa ukuphepha nokuphila kwamazinga angaphezu kweminyaka eyi-10, amadoda acabangela ukubhekwa okusebenzayo kufanele aqaphele ukuba khona kwanoma yikuphi isifo sezinga le-Gleason esingama-7 noma ngenhla nge-MRI ephakathi kwamanye amazwe okulandelwayo okulandelwa ukuhlolwa kwonyaka. Okwesibili, izinga lokusinda ne-radiation lilingana nokuhlinzwa kodwa kunemiphumela emibi kakhulu ye-urinary kanye nocansi. Ngaphandle kwemiphumela yaso yocansi, imisebe ibekezelela kahle kakhulu. Uma ukwelashwa kubonakala kuyadingeka, imisebe yindlela engcono kakhulu yokwelapha umdlavuza wesicathulo kunokuba uhlinzekwe.